The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 1999
Randomized Controlled Trial Clinical TrialHeparin-coated cardiopulmonary bypass equipment. II. Mechanisms for reduced complement activation in vivo.
Our objective was to study mechanisms for reduced complement activation by heparin coating of cardiopulmonary bypass equipment in clinical heart surgery. ⋯ C1 activation during bypass was increased by heparin coating, but further classical pathway activation was held in check until administration of protamine. Heparin coating significantly inhibited C3bc and terminal complement complex formation. Terminal complement complex concentrations were related to alternative pathway activation and may be useful for evaluation of differences in bypass circuitry. Increases and intergroup differences in terminal complement complex concentrations were much larger than those in C5a-desArg.
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J. Thorac. Cardiovasc. Surg. · Apr 1999
Comparative StudyIschemic preconditioning does not acutely improve load-insensitive parameters of contractility in in vivo stunned porcine myocardium.
Ischemic preconditioning has been shown to have no beneficial effect on segment shortening in in vivo regionally stunned myocardium. The purpose of this study was to determine whether ischemic preconditioning improves the recovery of postischemic ventricular function when contractility is assessed by load-insensitive measurements including end-systolic pressure length relations, preload recruitable stroke work, and preload recruitable stroke work area in in vivo regionally stunned porcine myocardium. ⋯ These results confirm that ischemic preconditioning does not ameliorate in vivo porcine myocardial stunning and indicate that ischemic preconditioning may have a limited cardioprotective role during cardiac operation.
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J. Thorac. Cardiovasc. Surg. · Apr 1999
Hyperbaric oxygen therapy for massive arterial air embolism during cardiac operations.
Massive arterial air embolism is a rare but devastating complication of cardiac operations. Several treatment modalities have been proposed, but hyperbaric oxygen is the specific therapy. ⋯ Hyperbaric oxygen therapy should be administered as soon as possible after massive arterial air embolism during cardiac operations.
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J. Thorac. Cardiovasc. Surg. · Apr 1999
Pulmonary thromboendarterectomy for chronic thromboembolic obstruction of the pulmonary artery in piglets.
The 2 main causes of death after thromboendarterectomy for chronic pulmonary thromboembolism are incomplete repermeabilization responsible for persistent pulmonary hypertension and acute high-permeability pulmonary edema. We wish to establish an experimental model of chronic pulmonary thromboembolism to replicate the conditions encountered during and after pulmonary thromboendarterectomy. ⋯ Our model replicated the perioperative conditions of pulmonary thromboendarterectomy, suggesting that it may prove useful for improving the repermeabilization technique and for investigating the mechanisms and prevention of reperfusion injury.
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J. Thorac. Cardiovasc. Surg. · Mar 1999
Randomized Controlled Trial Clinical TrialVenovenous modified ultrafiltration after cardiopulmonary bypass in children: a prospective randomized study.
Cardiopulmonary bypass is associated with the production of both proinflammatory and anti-inflammatory cytokines, the balance of which leads to varying degrees of postoperative systemic inflammation. Arteriovenous modified ultrafiltration effectively reduces total body water and improves postoperative hemodynamic and homeostatic functions. Venovenous modified ultrafiltration is a modification of this technique, which has the potentially added advantage of eliminating the obligatory left-to-right shunt associated with arteriovenous modified ultrafiltration. We tested the hypothesis that venovenous modified ultrafiltration is a safe and effective method of achieving ultrafiltration in children after cardiopulmonary bypass. ⋯ Venovenous modified ultrafiltration is a safe and effective method of reducing the increase in total body water and duration of postoperative convalescence after cardiopulmonary bypass.