Journal of cardiac surgery
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Adverse neurologic outcomes after cardiac surgery can have devastating consequences, among them increased mortality risk and, among survivors, loss of independence and a diminished quality of life. They also represent a burden on the health-care system, requiring prolonged hospitalizations and additional aftercare and, therefore, greater costs. Adverse outcomes are classified by their severity. ⋯ The benefits of strategies such as using low or high mean arterial pressures and manipulating pump flow remain unclear. Off-pump coronary bypass surgery has been proposed as a means of reducing neurologic risk, but its effectiveness is unproved in this area. One pharmacologic strategy, the administration of aprotinin, has been shown to reduce the incidence of stroke in high-risk patients.
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Comparative Study
Aortic arch reconstruction: safety of moderate hypothermia and antegrade cerebral perfusion during systemic circulatory arrest.
The ideal strategy for cerebral protection during aortic arch (AA) reconstructive surgery remains undefined. Antegrade cerebral perfusion (ACP) during systemic circulatory arrest (SCA) may provide superior results; however, optimal systemic temperature is undetermined. Our objective was to determine whether "deep" hypothermia is necessary during ACP with SCA, and whether the degree of hypothermia is associated with neurologic outcomes postoperatively. ⋯ In our experience, SCA with ACP was a safe technique for AA reconstructive surgery. The observation of a larger number of major neurologic injuries, and a trend toward a higher incidence of delirium in the <22 degrees C group, suggests that systemic temperatures below 22 degrees C may not be necessary and may be associated with a higher incidence of neurologic injury when using ACP during SCA.
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Comparative Study
A simple technique of distal limb perfusion during prolonged femoro-femoral cannulation.
Cannulation of the femoral vessels for cardiopulmonary support is a common approach for many cardiac procedures as well as access of choice for many emergency bypass systems such as extracorporeal membrane oxygenation. A serious complication of prolonged femoral cannulation remains the ischemic injury of the distal limb. ⋯ This technique of distal limb perfusion was found to be safe and effective in preventing lower limb ischemia for patients with prolonged femoral cannulation for extracorporeal circulatory support.
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Comparative Study
Effect of aprotinin on postoperative blood loss in off-pump coronary artery bypass surgery.
Off-pump coronary artery bypass (OPCAB) enables a reduction in postoperative complications, particularly bleeding and transfusion. Nevertheless, a significant percentage of patients still needs transfusion. The effect of antifibrinolytic therapy on postoperative bleeding as part of OPCAB is still not widely described. The purpose of this study was to investigate the potential benefit of aprotinin in OPCAB. ⋯ Aprotinin significantly reduced postoperative blood loss without reducing the transfusion rate. Aprotinin was not associated with any increase in postoperative complications.
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Comparative Study
Predictors of mid-term symptom recurrence, adverse cardiac events and mortality in 591 unselected off-pump coronary artery bypass graft patients.
Off-pump coronary artery bypass (OPCAB) grafting is gaining popularity; however, decreased mid-term graft patency and increased coronary reintervention rates are reported. ⋯ OPCAB grafting can be performed with low symptom recurrence, adverse cardiac events, and mortality rates. Modification of intra- and postoperative management strategies may improve outcomes.