The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2001
Comparative StudyCoronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction.
The effect of mild-to-moderate elevation of preoperative serum creatinine levels on morbidity and mortality from coronary artery bypass grafting has not been investigated in a large multivariable model incorporating preoperative and intraoperative variables. Our first objective was to ascertain the effect of a mild-to-moderate elevation in the preoperative serum creatinine level on the need for mechanical renal support; the duration of special care and total postoperative stay; the occurrence of infective, respiratory, and neurologic complications; and hospital mortality. Our second objective was to ascertain which patient variables contributed to an increase in the serum creatinine level in association with coronary artery bypass grafting. ⋯ A mild elevation (130-149 micromol. L(-1)) in the preoperative serum creatinine level significantly increases the need for mechanical renal support, the duration of special care and total postoperative stay, and the in-hospital mortality. As the preoperative serum creatinine level increases further (> or =150 micromol. L(-1)), this effect is more pronounced. No significant difference in outcome was observed between the use of cardioplegia or crossclamp fibrillation for myocardial protection.
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J. Thorac. Cardiovasc. Surg. · Jun 2001
Comparative StudyNeurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients.
We sought to assess the optimal strategy for avoiding neurologic injury after aortic operations requiring hypothermic circulatory arrest. ⋯ The occurrence of stroke is principally determined by patient- and disease-related factors, but use of antegrade cerebral perfusion can significantly reduce the occurrence of temporary neurologic dysfunction.
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J. Thorac. Cardiovasc. Surg. · Jun 2001
Comparative Study Clinical Trial Controlled Clinical TrialCerebral injury during cardiopulmonary bypass: emboli impair memory.
Cognitive deficits occur in up to 80% of patients after cardiac surgery. We investigated the influence of cerebral perfusion and embolization during cardiopulmonary bypass on cognitive function and recovery. ⋯ Cognitive deficits were common after cardiopulmonary bypass. Occult cerebrovascular disease was more severe than expected and predisposed to attention difficulties, whereas emboli caused memory deficits. We believe this to be the first report of differing cognitive effects from emboli and hypoperfusion.
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J. Thorac. Cardiovasc. Surg. · Jun 2001
Randomized Controlled Trial Comparative Study Clinical TrialSuperior hepatic mitochondrial oxidation-reduction state in normothermic cardiopulmonary bypass.
This study is the first comparative investigation of hepatic blood flow and oxygen metabolism during normothermic and hypothermic cardiopulmonary bypass. ⋯ Normothermic cardiopulmonary bypass provides adequate liver perfusion and results in a better hepatic mitochondrial redox potential than hypothermic cardiopulmonary bypass. Because arterial ketone body ratios reflect hepatic energy potential, normothermia was considered to be physiologically more advantageous for hepatic function.
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J. Thorac. Cardiovasc. Surg. · Jun 2001
Randomized Controlled Trial Comparative Study Clinical TrialClosure of atrial septal defects without cardiopulmonary bypass: the sandwich operation.
Cardiopulmonary bypass has adverse effects on patient physiology. A prospective randomized trial was undertaken to evaluate closure of atrial septal defects with or without cardiopulmonary bypass. ⋯ Closure of atrial septal defects without cardiopulmonary bypass can be done effectively. Adverse effects of cardiopulmonary bypass can be avoided, as shown by improvements of postoperative parameters with the sandwich operation.