Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Sep 2002
Randomized Controlled Trial Clinical TrialEffects of intravenous triiodothyronine during coronary artery bypass surgery.
A prospective randomized and double-blind study was performed to evaluate whether perioperative triiodothyronine administration has any effect on cardiovascular performance after coronary artery bypass surgery. Sixty patients were assigned to 2 groups of 30 each. When crossclamping ended, group A received an intravenous bolus of triiodothyronine, followed by infusion for 6 hours. ⋯ No significant differences were detected between the groups in the incidence of arrhythmia, the need for inotropic support, intensive care unit stay, mortality, and morbidity. Perioperative administration of triiodothyronine increased cardiac output slightly and decreased systemic vascular resistance, but it had no effect on operative outcome. Routine use after coronary surgery is thus not recommended.
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Asian Cardiovasc Thorac Ann · Sep 2002
ReviewSurgical steps toward complete revascularization in off-pump coronary bypass.
Surgical techniques aimed at complete myocardial revascularization without the use of cardiopulmonary bypass are described. Between January 1998 and June 2000, coronary artery bypass was performed in 3,003 patients; an off-pump technique was used in 676 and cardiopulmonary bypass was employed in 2,327. Patient characteristics, demography, and preoperative risk factors of the two groups were compared retrospectively, and differences in operative variables and postoperative outcomes were analyzed. Using a commercially available suction stabilization device and the surgical and anesthetic techniques described herein, off-pump coronary revascularization was accomplished with results comparable to the on-pump approach.
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Asian Cardiovasc Thorac Ann · Sep 2002
Comparative StudyOff-pump coronary artery surgery in the elderly.
We compared the results of off-pump (n = 186) and on-pump (n = 389) coronary artery bypass grafting in elderly patients over 70 years old. Patients undergoing single-vessel revascularization were excluded from the study. ⋯ The off-pump group fared better in intubation time (16 +/- 4 hours versus 25 +/- 5 hours), blood loss (365 +/- 58 mL versus 584 +/- 72 mL), the need for blood transfusion (31.7% versus 44%), reoperation for bleeding (0.5% versus 3.6%), atrial fibrillation (10.2% versus 18.5%), intensive care unit stay (21 +/- 8 hours versus 34 +/- 10 hours), and total hospital stay (5 +/- 2 days versus 8 +/- 3 days). Off-pump bypass surgery is thus safe for elderly patients and is associated with reduced morbidity and shorter hospitalization than on-pump surgery.
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Asian Cardiovasc Thorac Ann · Jun 2002
Clinical effects of different protamine doses after cardiopulmonary bypass.
The optimal dose of protamine needed to reverse the anticoagulant effect of heparin after cardiopulmonary bypass is still not known. In this retrospective cohort study, we investigated 3 different dose regimes in 300 patients undergoing coronary artery bypass grafting. Group A patients (n = 100) were given protamine in the ratio of 1.3 mg to 1 mg heparin, group B patients (n = 100) were given 0.75 mg protamine to 1 mg heparin, and group C patients (n = 100) were given protamine in fractionated doses of 1 mg + 0.15 mg + 0.15 mg to 1 mg heparin. ⋯ The rate of red cell transfusion was significantly higher in group B than in the other groups. A similar but nonsignificant trend was observed in the incidence of resternotomy for postoperative bleeding, mediastinal drainage, and postoperative hemoglobin loss. The study demonstrates that a single bolus dose of 1.3 mg protamine to 1 mg heparin is safe and efficient for neutralizing heparin after cardiopulmonary bypass.