The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1996
One-stage repair of interrupted aortic arch, ventricular septal defect, and subaortic obstruction in the neonate: a novel approach.
One-stage repair of interrupted aortic arch, ventricular septal defect, and severe subaortic stenosis represents a surgical challenge. Techniques that use extracardiac conduits to bypass the subaortic area or involve transaortic or transatrial resection of the conal septum have shown limitations and have failed to reduce the high mortality rate associated with subaortic obstruction. ⋯ Relief of severe subaortic stenosis during one-stage neonatal repair of aortic arch interruption and ventricular septal defect can be accomplished successfully without resection of the conal septum.
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J. Thorac. Cardiovasc. Surg. · Feb 1996
Comparative Study Clinical TrialComparison of hemodynamic performances of St. Jude Medical and CarboMedics 21 mm aortic prostheses by means of dobutamine stress echocardiography.
Dobutamine stress Doppler echocardiography was used to compare the hemodynamic performance of two small aortic bileaflet prostheses. Nineteen patients (14 female, mean age 64 years) who had undergone aortic valve replacement with 21 mm bileaflet valve prostheses (St. Jude Medical valve, n = 9, or CarboMedics valve, n = 10) were studied. ⋯ Dobutamine stress echocardiography is useful in the evaluation of the hemodynamic performance of prosthetic heart valves. St. Jude Medical and CarboMedics 21 mm prostheses have equally favorable hemodynamic performances in most patients under conditions of high cardiac output.
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J. Thorac. Cardiovasc. Surg. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSurface-bound heparin fails to reduce thrombin formation during clinical cardiopulmonary bypass.
The hypothesis that heparin-coated perfusion circuits reduce thrombin formation and activity; fibrinolysis; and platelet, complement, and neutrophil activation was tested in 20 consecutive, randomized adults who had cardiopulmonary bypass. Twenty identical perfusion systems were used; in 10, all blood-contacting surfaces were coated with partially degraded heparin (Carmeda process; Medtronic Cardiopulmonary, Anaheim, Calif.). All patients received a 300 U/kg dose of heparin. ⋯ Radioimmunoassay showed a significant increase in surface-adsorbed antithrombin on coated circuits but no significant differences between groups for other proteins. We conclude that heparin-coated circuits used with standard doses of systemic heparin reduce platelet adhesion and improve platelet function but do not produce a meaningful anticoagulant effect during clinical cardiopulmonary bypass. The data do not support the practice of reducing systemic heparin doses during cardiac operations with heparin-coated extracorporeal perfusion circuitry.
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J. Thorac. Cardiovasc. Surg. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialLeukocyte and platelet depletion with a blood cell separator: effects on lung injury after cardiac surgery with cardiopulmonary bypass.
This study was undertaken to assess the effects of leukocyte and platelet depletion on postoperative lung injury in 42 patients who underwent heart operations. Blood was serially sampled before, during, and after cardiopulmonary bypass, and leukocyte count, platelet count, and thromboxane B2 6-keto-PGF1 alpha, leukocyte elastase, thrombin-antithrombin III complex, and D-dimer levels were determined. Postoperative respiratory function was assessed based on analyses of oxygenation and carbon dioxide elimination. ⋯ The elimination of carbon dioxide was lower in the experimental group. Depletion of leukocytes and platelets reduced respiratory dysfunction after heart operations with cardiopulmonary bypass. It was particularly effective in patients with a low preoperative oxygenation capacity and in those for whom an extended period of cardiopulmonary bypass was required.