Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
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Ann Thorac Cardiovasc Surg · Feb 2001
ReviewCerebral protection during surgery for aortic arch aneurysms.
Surgical repair of aneurysms or dissections involving the transverse aortic arch and the distal aortic arch carries a considerable risk of cerebral complications. Currently, deep hypothermic circulatory arrest (DHCA), moderate hypothermic circulatory arrest or DHCA with selective cerebral perfusion (SCP) and DHCA with retrograde cerebral perfusion (RCP) are used as means to protect the central nervous system. ⋯ SCP offers virtually unlimited time in isolating cerebral circulation. With the improvement of cardiopulmonary bypass (CPB) materials and myocardial preservation, DHCA with SCP is our current preference of an adjunct for cerebral protection, although possible increment of mortality and morbidity associated with a prolonged DHCA and CPB remains to be overcome.
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Ann Thorac Cardiovasc Surg · Feb 2001
Randomized Controlled Trial Clinical TrialSlow induction of milrinone after coronary artery bypass grafting.
The aim of this study was to evaluate the hemodynamic effects of a slow induction of milrinone after open heart surgery. Twenty patients who underwent elective coronary artery bypass grafting were randomized into two groups, with 10 patients receiving a continuous infusion of milrinone (5 microg/kg/min) (group M), and 10 patients undergoing treatment without milrinone (group C). This is a preliminary study for evaluating the efficacy of a slow induction of milrinone, so patients in low cardiac output state were excluded. ⋯ Hypotension (systolic blood pressure less than 100 mmHg) or arrhythmia did not occur in group M. The concentration of milrinone at 90 minutes and 3 hours was 97+/-22 and 124+/-27 ng/ml, respectively. A slow induction of milrinone is safe and effective in patients following cardiac surgery.
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Ann Thorac Cardiovasc Surg · Feb 2001
Coronary artery bypass grafting within 30 days of an acute myocardial infarction.
Early surgical intervention is now often considered for symptomatic patients after an acute myocardial infarction. Conversely coronary artery bypass grafting soon after an acute myocardial infarction poses substantial risks. The present study was performed to evaluate the results of Coronary artery bypass grafting soon after an acute myocardial infarction. ⋯ If hemodynamic conditions can not be stabilized, then coronary artery bypass grafting using arterial grafts, when indicated, should be performed even early after AMI.
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Ann Thorac Cardiovasc Surg · Dec 2000
Case ReportsOff-pump total arterial bypass grafting using bilateral mammary, gastroepiploic, and radial artery.
The indication for off-pump coronary artery bypass grafting (CABG) have been expanded as development of the off-pump device has progressed. We present a case of four-vessel revascularization with total arterial graft under a beating heart. All conduits were in situ or composite, and bypass was performed with aorta non-touch technique. Off-pump bypass using in situ quadruple arterial conduits may contribute to a reduction of incidence of perioperative strokes and reduction of the postoperative cardiac events.
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Two types small and efficient ECMO oxygenators were developed utilizing the most up to date hollow fiber technology. Newly silicone hollow fibers possess sufficient mechanical strength while maintaining ultra thin walls of 50 micro meter. Two types of oxygenators were made with this fiber. ⋯ Additionally, comparative hemolysis tests were preformed with this new oxygenator and the Kolbow. The NIH value was 0.006 (g/100 L) for the type 1 oxygenator and 0.01 (g/100 L) for the Kolbow oxygenator. These results suggested that this ECMO oxygenator had sufficient gas exchange performance in spite of being smaller and induced minimal blood damage.