The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 1987
Blood conservation for myocardial revascularization. Is it cost effective?
A total of 284 patients undergoing myocardial revascularization were prospectively studied to determine if the use of intraoperative autotransfusion or intraoperative autotransfusion plus postoperative reinfusion of shed mediastinal blood decreased transfusion requirements and the use of one or both techniques was cost effective. The Haemonetics Cell Saver System was used for intraoperative autotransfusion and the Sorenson Receptaseal autotransfusion system for postoperative reinfusion of shed mediastinal blood. During Phase 1, the Cell Saver System was used for 57 patients and 93 patients served as a control group. ⋯ The total "blood-related costs" (including cost for all bank blood products plus Receptaseal and Cell Saver System equipment) was slightly lower for the blood conservation patients in both Phase 1 ($555.00 versus $615.00, no significant difference) and Phase 2 ($373.00 versus $426.00, no significant difference). Intraoperative use of the Cell Saver System is associated with substantial savings of bank blood, and the addition of postoperative reinfusion of shed mediastinal blood results in further bank blood savings. The use of blood conservation techniques is cost effective; that is, the costs incurred for the blood conservation equipment are more than offset by the resultant dollar savings for blood products.
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J. Thorac. Cardiovasc. Surg. · Apr 1987
Comparative StudyComparison of left ventricular assist and intra-aortic balloon counterpulsation during early reperfusion after ischemic arrest of the heart.
In most centers, intra-aortic balloon counterpulsation and inotrope infusion are used for patients who require support to be weaned from cardiopulmonary bypass at the end of a cardiac surgical procedure. Where available, early institution of a left ventricular assist device is an alternative with possible advantages. In a canine model of left ventricular failure caused by 45 minutes of normothermic ischemic arrest, these two methods of support were instituted after an initial 30-minute reperfusion period. ⋯ When the hearts were examined histologically, dogs in the group with intra-aortic balloon counterpulsation and inotrope infusion had significantly more necrosis than those in the group with a left ventricular assist device, 7.7% +/- 5.0% (mean +/- standard deviation) versus 2.0% +/- 1.3%. Decreases in compliance and systolic function were significantly greater in the group with intra-aortic balloon counterpulsation and inotrope infusion when compared with those supported with a left ventricular assist device. These findings suggest that even when support with intra-aortic balloon counterpulsation and inotrope infusion resulted in satisfactory hemodynamics, early institution of a left ventricular assist device was significantly more effective in preserving myocardial structure and function.
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J. Thorac. Cardiovasc. Surg. · Apr 1987
An evaluation of operative outcome in patients with funnel chest diagnosed by means of the computed tomogram.
A questionnaire survey of 66 patients with funnel chest who underwent corrective surgical procedures by the sternal elevation method, with or without the application of metal strut, demonstrated that the operative result was good in 60.6% and fair in 39.4%. None of the patients rated the result as unsatisfactory. A computed tomogram of the chest wall was performed to study the depression (b/c), asymmetry (b'/b), and flatness (a/b) of the chest wall, where a was the maximum transverse distance of the chest wall, b and b' were the maximum distance from the anterior to the posterior chest wall at the left and right sides (b greater than b'), and c was the perpendicular distance from the point of the anterior chest wall at its greatest deformity to the level of the anterior tip of the spine. ⋯ Moreover, 85.7% of the patients (6/7) with b/c over 3.0 before operation had a fair postoperative result. The degree of a/b was not corrected in patients with either good or fair postoperative results. We conclude that an operative approach to lengthen ribs would be necessary to improve the degree of a/b, that in patients with severely depressed funnel chest, expressed as a b/c value over 3.0 by computed tomography, a transient support with struts should be applied, and finally, that a more careful approach for correction of asymmetry should be undertaken to improve the operative results.