Journal of cardiac surgery
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Comparative Study
Heparin-bonded cardiopulmonary bypass circuits reduce bleeding and transfusion requirements in proximal aortic surgery.
Methods to improve hemostasis in aortic surgery continue to evolve. Use of heparin-bonded cardiopulmonary bypass circuits (HBC) has been shown previously to effectively reduce bleeding and improve outcomes in coronary and valve operations. ⋯ Use of HBC in proximal aortic surgery resulted in reduced bleeding and blood transfusion, improving clinical outcomes. Undoubtedly, multiple factors account for the overall improved results. However, use of HBC is an important component of an overall blood conservation strategy.
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Heparin-coated cardiopulmonary bypass (CPB) circuits have been reported to reduce complement activation and the inflammatory response associated with CPB. We retrospectively compared patients utilizing heparin-coated perfusion circuits with those using noncoated circuits to determine the clinical effects of the different circuits in pediatric cardiac surgery. ⋯ Patients operated on with the use of heparin-coated circuits had increased urine output during bypass and required less time postoperatively on the ventilator. These results suggest a reduction in the acute inflammatory response, capillary leakage, and overall systemic edema. We now routinely use coated circuits on all pediatric pump cases.
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Aneurysms and dissections of the thoracic aorta continue to present a surgical challenge and their incidence is increasing in recent years. The mortality rate of surgical treatment is still higher than those of other cardiovascular operations. Neurological injury is the most feared complication resulting from repair of these lesions. This study aims to determine the factors that influence the neurological outcome and mortality after thoracic aortic operations. ⋯ Hypothermic circulatory arrest with retrograde cerebral perfusion was not an independent predictor of neurological morbidity on multivariate analysis, even if the arrest period was more than 60 minutes. Lengths of circulatory arrest periods and clinical presentations of the patients are important determinants of mortality.
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Recently, the efficacy of video-assisted mitral valve surgery has been demonstrated. The evolution of this technology has been relatively rapid. In this article we review this development and predict the future of endoscopic and robotic-enabling technology for cardiac valve operations. ⋯ From this and other work reviewed, we conclude that video-assisted and computer-assisted robotic techniques are safe and may be the pathway to truly endoscopic mitral valve operations. We are encouraged regarding the use of this new technology for mitral valve operations.
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Despite the sizeable volume of research on the determinants of outcome after cardiac operations, few articles have analyzed the learning curves of individual cardiac surgeons over time. The objective of our study was to analyze statistically the learning curve of an academic cardiac surgeon in reducing operative morbidity and mortality during a 10-year interval. ⋯ The mortality rate after coronary artery bypass grafting and select perioperative morbidity rates improved in a linear fashion from the onset of independent practice to year 10. The CUSUM method was helpful in identifying suboptimal results during the first year of practice and shows promise as a method of prospective quality control in cardiac surgery. These data support mentorship of new consultants by a senior surgeon during the first year or two of independent practice.