The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Long-term outcome after coronary artery bypass grafting in cardiogenic shock or cardiopulmonary resuscitation.
Coronary artery bypass grafting carried out in patients in cardiogenic shock or receiving cardiopulmonary resuscitation is an infrequently performed procedure, disrupting the normal process with a dramatic early risk. These circumstances mandate an analysis of the benefit, including the early identification of the late survivors. ⋯ Coronary artery bypass grafting in cardiogenic shock or during cardiopulmonary resuscitation has an extremely high and protracted periprocedural risk but is balanced by a satisfactory late survival. An early prediction of the hospital survivors is difficult.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyA new role for cardioplegic buffering: should acidosis or calcium accumulation be counteracted to salvage jeopardized hearts?
Thirty minutes of unprotected ischemia produced a jeopardized heart that was treated with a blood cardioplegic solution containing the natural erythrocyte and protein buffers. Cardioplegic pH was changed to 7.7 (buffered) or 7.2 (nonbuffered), and this was tested alone and after pretreatment with Na(+)-H(+) exchange blockade (cariporide) to define their protective effects. ⋯ The severe ischemia-reperfusion injury of 30 minutes of normothermic ischemia is not altered by an acidic or alkalotic pH cardioplegic solution. Correction of damage is achieved by adding Na(+)-H(+) exchange blocker therapy before treatment with buffered and nonbuffered solutions; thus, sodium-hydrogen exchange inhibition plays a more vital role in recovery than pH management.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialAntifibrinolytic therapy during cardiopulmonary bypass reduces proinflammatory cytokine levels: a randomized, double-blind, placebo-controlled study of epsilon-aminocaproic acid and aprotinin.
Aprotinin is a broad-spectrum serine protease inhibitor that has been shown to attenuate the systemic inflammatory response in patients undergoing cardiac surgery with cardiopulmonary bypass. Although epsilon-aminocaproic acid is similar to aprotinin in its ability to inhibit excessive fibrinolysis (ie, plasmin activity and D-dimer formation), its ability to influence proinflammatory cytokine production remains unclear. This study was designed to compare the effects of epsilon-aminocaproic acid and aprotinin on plasma levels of interleukin-6 and interleukin-8 during and after cardiopulmonary bypass. ⋯ When dosed in a similar manner, epsilon-aminocaproic acid seems to be as effective as aprotinin at reducing interleukin-6 and interleukin-8 levels in patients undergoing primary coronary artery bypass graft surgery. These data indicate that suppression of excessive plasmin activity or D-dimer formation or both may play an important role in the generation of proinflammatory cytokines during and after cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialImproved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial.
We sought to determine whether a continuous regional infusion of a local anesthetic delivered to the operative site would result in decreased levels of postoperative pain and narcotic requirements for patients who undergo a standard median sternotomy for cardiac surgery. ⋯ Continuous delivery of local anesthetics significantly improved postoperative pain control while decreasing the amount of narcotic analgesia required in patients who underwent standard median sternotomy. There was also a significant decrease in hospital length of stay, which is likely to result in significant cost reductions.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialN-acetylcysteine prevents reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery: results of a randomized, double-blind, placebo-controlled clinical trial.
Reactive oxygen species have been shown to contribute to myocardial stress in patients undergoing cardiac surgery, as demonstrated by myocardial 8-iso-prostaglandin-F(2)alpha and nitrotyrosine formation. We hypothesized that the reactive oxygen species scavenger N-acetylcysteine attenuates reactive oxygen species-mediated myocardial stress in patients undergoing cardiac surgery. ⋯ Reactive oxygen species scavenging with N-acetylcysteine attenuates myocardial oxidative stress in the hearts of patients subjected to cardiopulmonary bypass and cardioplegic arrest.