The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialDoes the addition of albumin to the prime solution in cardiopulmonary bypass affect clinical outcome? A prospective randomized study.
Colloid solution is commonly used to increase the oncotic pressures of priming solutions used in the cardiopulmonary bypass circuit. To study the effectiveness of this practice, we prospectively randomized 100 adult patients undergoing cardiac operations to receive Ringer's lactate solution plus 50 gm of albumin (group A) or Ringer's lactate solution alone (group B) as the prime solution for the bypass circuit. Personnel involved in the management of these patients were blinded concerning the group to which the patients had been randomized. ⋯ We conclude that there is no clinically detectable advantage for the practice of adding 50 gm of albumin to the priming solution of bypass circuits in adults undergoing cardiac operations. Routinely supplementing the bypass prime solution with albumin adds significant cost, estimated to be approximately $10,000 per 100 cases, without demonstrable clinical benefits. Whether this practice can be of value in selected cases needs to be further studied.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Neurobehavioral outcomes in cardiac operations. A prospective controlled study.
To assess the severity and duration of new organic brain dysfunction after cardiac operations, we used an extensive battery of neuropsychologic tests to evaluate 65 patients undergoing coronary artery bypass grafting and 25 patients undergoing intracardiac operations with cardiopulmonary bypass. Patients were tested the day before the operation, before discharge from the hospital, and approximately 7 months later. Compared to 47 nonsurgical control subjects tested at comparable time intervals, surgical subjects showed generalized impairment of neuropsychologic abilities near the time of discharge from the hospital. ⋯ Neurobehavioral outcome was not related to the type of operation (coronary bypass versus intracardiac), to factors of cardiopulmonary bypass (duration, aortic occlusion time, hypotension, arterial carbon dioxide tension, minimum hematocrit value, minimum temperature). The only predictor of negative outcome was advanced age. We conclude that, although neurobehavioral impairment is common during hospitalization after cardiac operations, the prognosis for eventual full recovery is favorable, although less so among the elderly.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Comparative StudyRole of extracorporeal membrane oxygenation in selected pediatric respiratory problems.
Between 1984 and 1988, 89 infants and children with severe respiratory failure were supported by extracorporeal membrane oxygenation. Major clinical diagnoses included congenital diaphragmatic hernias (34), meconium aspiration syndrome (26), and sepsis (8). Extracorporeal membrane oxygenation was used for patients with a predicted mortality rate of at least 80% based on an oxygenation index greater than 0.4. ⋯ Mechanical circuit complications were seen in 22% but rarely related to significant morbidity. Extracorporeal membrane oxygenation appears to provide effective cardiopulmonary support for selected pediatric respiratory problems. It affords those with potentially reversible pathophysiology the temporal opportunity for successful medical or surgical therapies.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients.
Ascending aorta and/or aortic arch reconstruction by composite valve graft (281, 39%), separate valve graft (117, 16%), graft only (256, 36%), and other procedures (63, 9%) was used for aneurysm or dissection caused by trauma (6), infection (20), aortitis (46), dissection (261: acute 72, chronic 189), and medial degeneration (384) in 717 patients during the 9-year period between Jan. 11, 1980, and Jan. 16, 1989. Of these, 150 had 173 previous heart or aortic operations and needed reoperation for progression or recurrence of aneurysm, rupture, valvular insufficiency, aortocutaneous or aorta-heart chamber fistulas, great vein or airway obstruction, and infection. Concurrent distal aneurysmal disease was present or developed in 267 (37%) patients, being most prevalent in patients with arch involvement (211/395, 53%). ⋯ Late survival rates (Kaplan-Meier) were 66% and 57% at 5 and 7 years. Independent predictors of death were severe aneurysm symptoms, preoperative angina, extent of proximal replacement, associated residual distal aneurysm, balloon pump, renal dysfunction, cardiac dysfunction, and stroke. Five-year survival rates varied with the incidence of the four preoperative variables and age in a single patient: 78% in 413 patients with up to one variables, 57% in 193 patients with two or three, and 39% in 111 patients with three or four (p less than 0.0001).
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Biography Historical ArticleEight former presidents of the AATS. The Boston connection.