The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialSystemic oxygen uptake during hypothermic cardiopulmonary bypass. Effects of flow rate, flow character, and arterial pH.
A factorial experiment was undertaken to study the effects on systemic oxygen uptake of alteration in flow rate between 1.5 and 2.0 L.min-1.m-2, flow character between nonpulsatile or pulsatile perfusion, and acid-base management between attempted pH and alpha stat control during hypothermic cardiopulmonary bypass. Twenty-four patients undergoing elective coronary bypass were studied. After 10-minute periods of stability at moderate hypothermia (28 degrees +/- 1 degrees C), blood samples were aspirated from the arterial and venous lines. ⋯ Lactate concentrations were unaffected by flow rate, flow character, or arterial pH, but there was a small but significant overall decrease during the course of cardiopulmonary bypass (p less than 0.05). Reasons why systemic oxygen uptake was affected by flow rate but not by flow character or arterial pH are discussed. A flow rate of 1.5 L.min-1.m-2 during cardiopulmonary bypass with moderate hypothermia results in a less than maximal systemic oxygen uptake.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Case ReportsCatastrophic consequences of internal mammary artery hypoperfusion.
Inappropriate use of the internal mammary artery for complex coronary artery bypass operations may have disastrous yet avoidable consequences. In 712 consecutive coronary artery bypass operations performed between January 1985 and September 1986, five patients had an intraoperative course suggesting internal mammary artery hypoperfusion. In three, coronary artery bypass was performed as a reoperative procedure. ⋯ Internal mammary artery hypoperfusion typically occurred 30 to 40 minutes after discontinuation of cardiopulmonary bypass but was also seen in the intensive care unit. The condition may be confused with internal mammary artery or coronary artery spasm. It may be avoided by careful prebypass planning of the operation, intraoperative assessment of internal mammary artery flow and size with prudent use of sequential internal mammary artery grafting, avoiding use of the terminal left anterior descending (unless large), retaining nonobstructed saphenous vein grafts when the internal mammary artery has marginal flow or size, and placement of a saphenous vein graft distal to the left internal mammary artery when size or flow in the latter is small.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Biography Historical ArticleC. Walton Lillehei and his trainees: one man's legacy to cardiothoracic surgery.
Between 1951 and 1967, Dr. C. Walton Lillehei trained 134 cardiothoracic surgeons at the University of Minnesota Hospital. ⋯ A total of at least 820 cardiothoracic surgeons, currently residing in 36 countries, can trace their preceptor lineage back to Dr. Lillehei. A number of significant clinical and research contributions have been forthcoming from these Lillehei trainees during the past 35 years.
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J. Thorac. Cardiovasc. Surg. · Oct 1989
The role of prophylactic cranial irradiation in regionally advanced non-small cell lung cancer. A Southwest Oncology Group Study.
Lung cancer is the most common malignant disease in the United States. Only the few tumors detected very early are curable, but there has been some progress in the management of more advanced non-small cell lung cancer, particularly in regionally inoperable disease. Prevention of central nervous system relapse is an important issue in this group of patients because brain metastases ultimately develop in 20% to 25% of them. ⋯ Both of these patients received 300 cGy per fraction of irradiation. The use of prophylactic cranial irradiation has been controversial, but its safety and efficacy in this trial supports its application in a group of patients at high risk for central nervous system relapse. Further evaluation of prophylactic cranial irradiation in clinical trials for regionally advanced non-small cell lung cancer is warranted.
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J. Thorac. Cardiovasc. Surg. · Oct 1989
Predictors of excessive blood use after coronary artery bypass grafting. A multivariate analysis.
One hundred fifty-nine consecutive patients who underwent coronary artery bypass grafting were studied to determine clinical and laboratory predictors of excessive postoperative packed red blood cell transfusion. Consideration of the distribution of packed red blood cells administered revealed that the patients could be divided into two groups: those patients who received 5 units of red blood cells or less (group I, n = 139) and those patients who received more than 5 units of packed red blood cells (group II, n = 20). The Mann-Whitney test or Fisher's exact test was used whenever appropriate to test differences between these two groups with respect to twelve patient variables. ⋯ This nomogram suggests that a ratio of bleeding time to red blood cell volume of 0.0071 or greater is associated with a greater than 70% chance of requiring more than 5 units of packed red blood cells. We conclude that preoperative bleeding time and red blood cell volume are useful predictors of excessive postoperative blood transfusion. These results suggest that factors other than aspirin therapy may be associated with bleeding time prolongation leading to excessive postoperative transfusion.