The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · May 1999
Multicenter Study Comparative StudyPrognostic models of thirty-day mortality and morbidity after major pulmonary resection.
A part of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program was developed to predict 30-day mortality and morbidity for patients undergoing a major pulmonary resection. ⋯ This analysis identifies independent patient risk factors that are associated with 30-day mortality and morbidity for patients undergoing a major pulmonary resection. This series provides an initial risk-adjustment model for major pulmonary resections. Future refinements will allow comparative assessment of surgical outcomes and quality of care at many institutions.
-
J. Thorac. Cardiovasc. Surg. · May 1999
Comparative StudyLong-term outcome after biologic versus mechanical aortic valve replacement in 841 patients.
The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. ⋯ For first-time, isolated aortic valve replacement, mechanical prostheses should be considered in patients under age 65 years with a life expectancy of at least 10 years. Bioprostheses should be considered in patients over age 65 years or with lung disease (in patients over age 60 years), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.
-
J. Thorac. Cardiovasc. Surg. · May 1999
Comparative StudyPlatelet anesthesia with nitric oxide with or without eptifibatide during cardiopulmonary bypass in baboons.
This study tested the hypothesis that nitric oxide or nitric oxide and eptifibatide (Integrilin) reversibly inhibit platelet activation and consumption during cardiopulmonary bypass and rapidly restore platelet numbers and function after bypass. ⋯ Nitric oxide with or without eptifibatide protects platelets during cardiopulmonary bypass and accelerates restoration of normal bleeding times after operation in a baboon model. Although nitric oxide and eptifibatide reversibly inhibit platelets by different mechanisms, in the absence of a wound no synergistic effect was demonstrated.
-
J. Thorac. Cardiovasc. Surg. · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialDoes steroid pretreatment increase endotoxin release during clinical cardiopulmonary bypass?
The mechanism involved in the endotoxemia frequently recognized during cardiopulmonary bypass remains unclear. It has also been suggested that endotoxin levels were higher in steroid-pretreated patients undergoing cardiopulmonary bypass. ⋯ Endotoxin is released during cardiopulmonary bypass from the region drained by the inferior vena cava. Steroid pretreatment may actually reduce endotoxin release during bypass.
-
J. Thorac. Cardiovasc. Surg. · May 1999
Comparative StudyEarly experience with minimally invasive direct coronary artery bypass grafting with the internal thoracic artery.
Minimally invasive direct coronary artery bypass is performed under direct vision without sternotomy or cardiopulmonary bypass. The technique can be used in both primary and reoperative cases by employing the internal thoracic artery to perform arterial revascularization of the anterior surface of the heart. ⋯ Anterior minimally invasive direct coronary artery bypass grafting with the internal thoracic artery avoids the risks of repeated sternotomy, aortic manipulation, and cardiopulmonary bypass. There was a low rate of reintervention, and patients had excellent resolution of anginal symptoms. Postoperative length of stay was comparatively short, and continued follow-up will be essential to evaluate long-term graft patency and patient survival.