The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1993
Comparative StudyVenovenous compares favorably with venoarterial access for extracorporeal membrane oxygenation in neonatal respiratory failure.
Traditional extracorporeal membrane oxygenation via the venoarterial route requires cannulation and ligation of the internal jugular vein and common carotid artery. Concerns about ligation of the common carotid artery prompted development of a 14F double-lumen internal jugular vein cannula for venovenous oxygenation for neonates with respiratory failure. We retrospectively compared 22 patients supported by venovenous bypass and 20 patients supported with traditional venoarterial bypass. ⋯ There were no documented neurologic injuries in the patients managed with venovenous bypass. There were no deaths in either group. Venovenous extracorporeal membrane oxygenation through a double-lumen cannula can adequately provide respiratory support for neonates with pulmonary failure and effectively avoids ligation of the common carotid artery.
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J. Thorac. Cardiovasc. Surg. · Aug 1993
Transhiatal versus transthoracic esophagectomy for esophageal cancer.
We retrospectively analyzed 238 patients with esophageal carcinoma treated between 1983 and 1991; 120 underwent transthoracic esophagectomy, and 118 underwent transhiatal esophagectomy. The two groups were statistically similar in preoperative characteristics, except that upper esophageal cancer was more frequent in the transhiatal esophagectomy group than in the transthoracic esophagectomy group (p < 0.01). The rate of postoperative complications differed significantly in wound infection (21% in patients who underwent transthoracic esophagectomy, 10% in those who underwent transhiatal esophagectomy; p < 0.05) and empyema (11% with transthoracic esophagectomy, 1% with transhiatal esophagectomy; p < 0.01). ⋯ Late complication rate was lower with transhiatal esophagectomy than with transthoracic esophagectomy (11% and 51%, respectively). There was no significant difference in actuarial survival of patients in both groups. Transhiatal esophagectomy, which can be performed in almost all levels of the esophagus, is the safer of the two operations.
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J. Thorac. Cardiovasc. Surg. · Aug 1993
Detrimental effects of interrupting warm blood cardioplegia during coronary revascularization.
Warm blood cardioplegia has emerged as a substitute for cold blood cardioplegia as a method of myocardial protection. However, the continuous infusion of blood in this technique may obscure the operative field and necessitate interruption of warm blood cardioplegia. This experimental study was therefore undertaken to determine whether interrupting warm blood cardioplegia during coronary revascularization would increase myocardial damage. ⋯ After aortic unclamping, the coronary snares were released and all hearts were reperfused for 180 minutes. Interrupting retrograde warm blood cardioplegia resulted in more tissue acidosis during cardioplegic arrest (6.20 +/- 0.16 interrupted retrograde warm blood cardioplegia and 6.45 +/- 0.12 continuous retrograde warm blood cardioplegia, both p < 0.05 compared with 6.98 +/- 0.17 intermittent antegrade and retrograde cold blood cardioplegia), decreased echocardiographic wall-motion scores (4 [normal] to -1 [dyskinesis]; 2.06 +/- 0.30 interrupted retrograde warm blood cardioplegia, p < 0.05 compared with 3.30 +/- 0.40 intermittent antegrade and retrograde cold blood cardioplegia, 2.80 +/- 0.40 continuous retrograde warm blood cardioplegia), and increased tissue necrosis as measured by the area of necrosis/area at risk (38% +/- 5% interrupted retrograde warm blood cardioplegia, p < 0.05 compared with 21% +/- 2% intermittent antegrade and retrograde cold blood cardioplegia; 25% +/- 2% continuous retrograde warm blood cardioplegia). We concluded that interrupting warm blood cardioplegia during coronary revascularization diminishes the effectiveness of warm blood cardioplegia and results in increased ischemic damage.