The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 1994
Randomized Controlled Trial Comparative Study Clinical Trial Retracted PublicationInfluence of aprotinin on the thrombomodulin/protein C system in pediatric cardiac operations.
Thirty consecutive children scheduled for pediatric cardiac operation with cardiopulmonary bypass were included in the study. Before the operation, the patients were randomly divided into two groups: with aprotinin (n = 15, 30,000 U/kg after induction of anesthesia, 30,000 U/kg added to the prime of the cardiopulmonary bypass or without aprotinin (n = 15). Thrombomodulin, (free) protein S, protein C, and thrombin/antithrombin III complex were measured from arterial blood samples taken after induction of anesthesia (at baseline, before aprotinin) and before, during, and after cardiopulmonary bypass until the first postoperative day. ⋯ Blood loss and the need for homologous blood and blood products did not differ significantly between the two groups. We concluded that administration of aprotinin resulted in reduced thrombomodulin plasma levels in pediatric patients undergoing cardiac operation without altering protein C/protein S plasma concentration. The exact role of aprotinin in endothelium-derived coagulation should be further studied.
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J. Thorac. Cardiovasc. Surg. · May 1994
Neutrophil-mediated acute lung injury after extracorporeal perfusion.
A pulmonary injury of varying severity occurs routinely after cardiopulmonary bypass. We studied the pulmonary complications of partial cardiopulmonary bypass in four groups of dogs to better define the injury and to evaluate the efficacy of two interventions (addition of a leukocyte filter or cyclooxygenase inhibition) on preservation of systemic oxygenation. All animals received a standard anesthetic (pentobarbital, morphine, and vecuronium) and, after sternotomy, three groups of animals received 3 hours of partial cardiopulmonary bypass. ⋯ Pretreatment with indomethacin ameliorated the decrease in arterial oxygen tension from prebypass to postbypass values (477 +/- 50 mm Hg versus 339 +/- 57 mm Hg, respectively). Similarly use of a leukocyte filter reduced the decline in arterial oxygen tension from prebypass to postbypass values (440 +/- 71 mm Hg versus 311 +/- 73 mm Hg, respectively). We believe that indomethacin ameliorates the decline in systemic oxygenation associated with bypass by augmentation of hypoxic pulmonary vasoconstriction and that the leukocyte filter acted to reduce pulmonary edema and thereby minimized intrapulmonary shunt.
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J. Thorac. Cardiovasc. Surg. · May 1994
Comparative StudyReduction of homologous blood requirements by blood-pooling at the onset of cardiopulmonary bypass.
This study was done to investigate whether an intraoperative autologous blood donation (pooling) at the onset of cardiopulmonary bypass can reduce homologous blood requirements during and after operations for myocardial revascularization. Ninety patients were assigned equally to two groups. In group C, serving as the control group, cardiopulmonary bypass was done with a membrane lung primed with 1500 ml of Ringer's solution. ⋯ Remarkably, 44% of patients in group P did not require any homologous blood products compared with 16% in group C. In conclusion, modern oxygenators, which provide sufficient oxygen transport capacity, make it feasible to decrease the hematocrit to 20% by "pooling" blood at the beginning of cardiopulmonary bypass and replacing it with saline solution. This procedure led to a highly significant saving of homologous blood.
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J. Thorac. Cardiovasc. Surg. · May 1994
Comparative StudyComparative experimental study between retrograde cerebral perfusion and circulatory arrest.
To evaluate the efficacy of retrograde cerebral perfusion in protecting the brain, we comparatively studied retrograde cerebral perfusion and total circulatory arrest in 18 hypothermic (20 degrees C) mongrel dogs (retrograde cerebral perfusion, n = 10; total circulatory arrest, n = 8). Retrograde cerebral perfusion was performed, maintaining an external jugular venous pressure of 25 mm Hg for 60 minutes. Retrograde cerebral perfusion provided half the cerebral blood flow and a third of the oxygen that was supplied during hypothermic cardiopulmonary bypass, which had a flow rate of 100 ml/min per kilogram. ⋯ These changes were smaller than those seen in total circulatory arrest. Tissue concentrations of adenosine triphosphate in the brain remained relatively high during retrograde cerebral perfusion but decreased rapidly during total circulatory arrest (0.49 +/- 0.16 versus 0.21 +/- 0.05 mmol/gm, p < 0.01, just before resuming cardiopulmonary bypass). Retrograde cerebral perfusion cannot maintain aerobic metabolism but may reduce ischemic damage of the brain and may safely extend the cerebral circulation interruption time.