The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 1989
Comparative StudyComparison of three cardioplegic solutions during hypothermic ischemic arrest in neonatal blood-perfused rabbit hearts.
Inadequate myocardial preservation continues to be an important cause of postoperative morbidity and mortality after pediatric cardiac operations. To investigate methods of improving preservation in neonatal myocardium, we compared three cardioplegic solutions with topical hypothermia during 120 minutes of ischemic arrest in isolated, blood-perfused, neonatal rabbit hearts. Topical hypothermia (15 degrees C) without cardioplegia resulted in 71% +/- 5% recovery of preischemic contractile function. ⋯ Thomas' Hospital and Hôpital Lariboisiere cardioplegic solutions resulted in recoveries of 89% +/- 6% and 88% +/- 7%, respectively, both of which were significantly greater (p less than 0.001) than recoveries obtained with the high potassium solution or hypothermia alone. Thus the cardioplegic solutions used at St. Thomas' Hospital and Hôpital Lariboisiere provided excellent protection during 2 hours of hypothermic ischemic arrest in neonatal rabbit hearts and resulted in functional recovery superior to that achieved with hypothermia alone or with the high potassium cardioplegic solution.
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J. Thorac. Cardiovasc. Surg. · Dec 1989
Wound complications after median sternotomy. Relationship to internal mammary grafting.
Case histories of 2582 patients requiring median sternotomy for coronary artery bypass grafting between January 1982 and August 1986 were retrospectively reviewed. Only saphenous vein grafts were used in 230 patients, one mammary artery graft was used in 1626 patients, and both mammary arteries were used in 726 patients. The relationship of potential risk factors and wound complication was evaluated. ⋯ Bilateral mammary grafting increased the chance of wound complication nearly five times that of saphenous vein grafting and three times that of single mammary grafting. Mammary artery grafts have been shown to achieve greater long-term patency than saphenous vein grafts, and their continued use is encouraged. However, the potential for increased wound problems should be considered along with other significant preoperative risk factors such as insulin-dependent diabetes, chronic pulmonary disease, and obesity.
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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
ReviewPartial anomalous pulmonary venous connection to the right side of the heart.
Partial anomalous pulmonary venous connection to the right side of the heart often complicates surgery for atrial septal defects. Between 1964 and 1987, 39 patients, ranging from 2 to 52 years old, underwent repair of partial anomalous pulmonary venous connection. At least one anomalous pulmonary vein arose from the right upper lobe in 38 patients and right middle lobe in 30 patients and connected to the superior vena cava in 28 patients and the right atrium only in 11 patients. ⋯ All patients remain well over long follow-up (1 to 24 years). Postoperative catheterization or echocardiography has revealed no intracardiac defects, pulmonary venous obstruction, or superior vena cava obstruction (except the one technical error). Correction of partial anomalous pulmonary venous connection should be individualized according to the site of connection of the anomalous pulmonary veins and the location of the atrial defect to minimize undesirable postoperative sequelae often associated with other methods of repair.
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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.