The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1994
Randomized Controlled Trial Clinical TrialAprotinin significantly decreases bleeding and transfusion requirements in patients receiving aspirin and undergoing cardiac operations.
Patients with heart disease are frequently maintained on a regimen of aspirin because of its ability to decrease thrombotic complications and reduce the prevalence of unstable angina and myocardial infarction. Aspirin-induced platelet acetylation also increases bleeding caused by impairment of platelet function during cardiac surgery. ⋯ High-dose aprotinin significantly reduces blood loss and red blood cell transfusions in patients receiving aspirin who undergo cardiac operations.
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J. Thorac. Cardiovasc. Surg. · Feb 1994
Comparative StudyEffects of cardioplegic arrest on left ventricular systolic and diastolic function of the intact neonatal heart.
The effects of cardiopulmonary bypass and cardioplegic arrest on left ventricular systolic and diastolic function were studied in 20 intact neonatal lambs instrumented with ultrasonic dimension transducers and micromanometers for collection of left ventricular pressure-dimension data. Group I lambs underwent 2 hours of hypothermic cardiopulmonary bypass (25 degrees C) alone; group II lambs underwent 2 hours of hypothermic cardiopulmonary bypass (25 degrees C) with 1 hour of multidose, cold, crystalloid cardioplegic arrest (St. Thomas' Hospital No. 2 solution). ⋯ Second, preload behaved as though fixed, resulting in a loss of impedance matching (afterload mismatch). Although contractility as assessed by the end-systolic pressure-dimension relationship was significantly increased (because of increased levels of circulating catecholamines), global systolic performance as quantified by the stroke work/end-diastolic length relationship remained unchanged, reflecting the afterload sensitivity of the latter parameter in the face of fixed preload. We conclude that cardiopulmonary bypass in the intact neonate results in a loss of compliance and impedance matching rather than a loss of contractility; however, the addition of 1 hour of cold, crystalloid cardioplegic arrest results in no dysfunction beyond that attributable to cardiopulmonary bypass alone.
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J. Thorac. Cardiovasc. Surg. · Feb 1994
Clinically relevant diaphragmatic dysfunction after cardiac operations.
Phrenic nerve injury and diaphragmatic dysfunction can be induced by cardiac operation. The clinical consequences are not well-established. We evaluated 13 consecutive patients over a 2-year period with unexplained and prolonged difficulties in weaning from mechanical ventilation. ⋯ Estimating the prevalence of clinically relevant diaphragmatic dysfunction, we found it to be 0.5% when no topical cooling was used and 2.1% when iced slush with no insulation pad was added for myocardial protection (p < 0.005). The most striking finding was that the clinical course of the 13 patients was marked by severe intercurrent events, including cardiorespiratory arrest after early tracheal extubation in 5 patients, nosocomial pneumonia in 11, prolonged mechanical ventilation in all (58 +/- 41 days), and a fatal outcome in 3. We conclude that prolonged postoperative diaphragmatic dysfunction may cause severe life-threatening complications after cardiac operation and can be limited to some extent by avoiding the use of iced slush topical cooling of the heart.
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J. Thorac. Cardiovasc. Surg. · Feb 1994
Retransplantation in heart-lung recipients with obliterative bronchiolitis.
Obliterative bronchiolitis remains the leading cause of morbidity and mortality in long-term survivors after heart-lung transplantation. Despite enhanced immunosuppressive therapy, a significant number of patients progress to end-stage respiratory failure, leaving retransplantation as the only potential therapeutic option. Between October 1986 and August 1990, 25 heart-lung recipients (mean age 22 +/- 2 years) underwent repeat heart-lung transplantation at an average of 21 months after their first procedure. ⋯ We also noted trends for improved survival in patients who had retransplantation at least 18 months after their original transplantation and in patients with negative preoperative sputum cultures. Retransplantation is a high-risk procedure that can result in rehabilitation in otherwise incapacitated patients. Single lung retransplantation appears to be the preferred option in carefully selected patients.
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J. Thorac. Cardiovasc. Surg. · Feb 1994
Result of biventricular repair for double-outlet right ventricle.
The choice of optimal repair for many patients with double-outlet right ventricle continues to challenge the heart surgeon. We present the results of a 10-year surgical experience with the biventricular repair for double-outlet right ventricle with situs solitus and atrioventricular concordance. Preoperative anatomic findings within this population of 73 patients are detailed. ⋯ The median age at repair in this series was 0.76 years, and there was a nonsignificant trend (p = 0.13) for early mortality in patients younger than 1 year of age. These patients tended to have other serious cardiac anomalies associated with double-outlet right ventricle that necessitated early operation. On the basis of these data, we favor early repair for double-outlet right ventricle if possible.