The Journal of thoracic and cardiovascular surgery
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Information on the role of the intensivist in postoperative cardiovascular patient care was obtained from a national survey of cardiac surgeons. The cardiac surgeon today retains overall responsibility for patient care. ⋯ Intensivists are less likely to practice in nonteaching hospitals and less likely to be present in those cardiac surgical units that are not combined with other services. Because of the preponderance of intensivists in training programs, the surgical resident's role in patient care may be reduced in the future.
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J. Thorac. Cardiovasc. Surg. · Apr 1984
Comparative StudyUse of the pulmonary artery for left ventricular venting during cardiac operations.
Data relating to the hemodynamic efficaciousness and mechanism of action of a pulmonary artery catheter or vent used for left ventricular venting during cardiac operations are presented. The pulmonary artery vent is a plastic sump catheter that is introduced into the main pulmonary artery through a purse-string suture and connected via a roller pump to the venous reservoir of the heart-lung perfusion machine. Placement and removal require only a few minutes. ⋯ The effectiveness of left ventricular decompression was evaluated in 20 patients also undergoing bypass grafting. Use of the pulmonary artery vent consistently and significantly decreased left heart pressures, compared to the control situation with the vent off, with the aortic cross-clamp applied, and in both the fibrillating and beating heart in the early postischemic reperfusion period. We reached the following conclusions: (1) The pulmonary artery vent withdraws left heart blood via the pulmonary vasculature, in addition to returning right heart spillover and retrieving bronchial flow. (2) Left heart pressures are reduced to levels which reduce oxygen demands and preserve endocardial perfusion, therefore protecting myocardium, during fibrillation and during coronary reperfusion of the beating heart. (3) Because of its effectiveness and safety, especially the impossibility of introducing air into the left ventricle, the pulmonary artery vent is recommended for routine left ventricular venting.
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J. Thorac. Cardiovasc. Surg. · Apr 1984
Favorable ten-year experience with valve procedures for active infective endocarditis.
We have reviewed our 1972 to 1982 experience with valve procedures for infective endocarditis in 52 consecutive patients to evaluate the results of an interdisciplinary policy of early operation for uncontrolled complications. There were 47 patients with native valve endocarditis and five with prosthetic valve endocarditis. Twenty-seven were drug addicts and 25 were not. ⋯ The late actuarial survival rate was 64% at 5 years and 54% at 10 years. Seven of nine deaths in the addict group were related to continued drug use, with five deaths occurring in the first 18 months. These results support a policy of early operation for uncontrolled complications with attention to the particular problems of active endocarditis.
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J. Thorac. Cardiovasc. Surg. · Apr 1984
Comparative StudyBrain damage in profound hypothermia. Perfusion versus circulatory arrest.
To investigate brain changes in induced deep core hypothermia (18 degrees C) with or without circulatory arrest, four groups of dogs were subjected to cardiopulmonary bypass (CPB) under the following conditions: (1) differential head perfusion with pulsatile flow and simultaneous circulatory arrest to the rest of the body; (2) differential perfusion to the head with a nonpulsatile flow; (3) total circulatory arrest; and (4) continuous hypothermic perfusion. Parameters analyzed were: (1) blood flow distribution; (2) creatine kinase isoenzyme (CK-BB) elevation in the cerebrospinal fluid (CSF) and in the brain venous return; and (3) microscopy of the brain in animals killed at 30 minutes, 24 and 48 hours, 1 and 2 weeks, and 1 month. ⋯ Rise of CK-BB levels occurred in brain venous return but not in CSF in all groups. Microscopic cellular damage appeared in all groups with an equal degree of severity, regardless of the method of hypothermia and perfusion implemented.