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
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
Pulmonary allograft conduit repair of tetralogy of Fallot. An alternative to transannular patch repair.
Cryopreserved allograft valves and valved conduits have been used in 122 patients during the past 3 years for surgical repair of congenital heart disease. In 55 of these patients, the right ventricular outflow tract was reconstructed with a pulmonary allograft conduit. Although most children requiring a conduit had complex lesions, 12 patients with tetralogy of Fallot without pulmonary atresia or absent valve syndrome have been treated in this manner since April 1985. ⋯ The operative mortality rate from a number of series for transannular patch repair of tetralogy of Fallot averages 16%, ranging from 3% to 63%. However, when distal pulmonary artery problems are added as a risk factor this rate rises to 21%, and valved conduit insertion increases the mortality rate (Kirklin and Barratt-Boyes, 1986). Although not clearly superior, pulmonary artery conduit repair of tetralogy of Fallot achieves results comparable with those of transannular patch repair and is recommended as an alternative, particularly when distal pulmonary artery anatomy is abnormal or vascular resistance is elevated.