The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1985
Cryoprecipitate-topical thrombin glue. Initial experience in patients undergoing cardiac operations.
The use of fibrin glues as topical hemostatic agents is reported in the European literature. We have composed an analogous compound in our operating rooms using cryoprecipitate and topical thrombin (1000 units/ml) in equal volumes applied directly to the bleeding site. We have used cryoprecipitate-topical thrombin glue in 26 patients undergoing cardiac operations. ⋯ In 16 patients followed for 9 to 12 months postoperatively, no hepatitis has occurred. The highly concentrated fibrinogen in cryoprecipitate is activated by thrombin to form fibrin and bring about rapid hemostasis. Cryoprecipitate-topical thrombin glue is a readily available, reliable, and inexpensive topical hemostatic agent in the patient undergoing a cardiac operation.
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J. Thorac. Cardiovasc. Surg. · Oct 1985
Results of reoperation for primary tissue failure of porcine bioprostheses.
Results of reoperation for primary tissue failure of porcine bioprostheses were evaluated in 574 patients discharged from the hospital from 1970 to 1981. A total of 413 had undergone isolated mitral valve replacement and 161 isolated aortic valve replacement. Through March, 1984, 88 patients (15%) had required reoperation: 59 had undergone mitral and 29, aortic valve replacement. ⋯ Bioprosthetic failure was caused by an intracuspal hematoma in one patient with mitral valve replacement and by lipid infiltration of the cusps in one patient with aortic valve replacement. Actuarial freedom from bioprosthetic primary tissue failure at 12 years is 61% +/- 5% for the mitral group and 69% +/- 7% for the aortic group. On the basis of our long-term follow-up of patients after mitral or aortic replacement with a porcine bioprosthesis, we conclude: primary tissue failure is the most frequent indication for reoperation in patients with a porcine bioprosthesis; calcification of the cusp tissue is the leading cause of primary tissue failure; reoperation for primary tissue failure may be a major concern, although mortality for elective cases is low; and the limited durability of porcine bioprostheses suggests their use be restricted to selected patients.
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J. Thorac. Cardiovasc. Surg. · Sep 1985
Physiological rationale for a bidirectional cavopulmonary shunt. A versatile complement to the Fontan principle.
The original Fontan procedure included a classic superior vena cava-to-right pulmonary artery (Glenn) shunt. Subsequent experience demonstrated that this anastomosis was not essential and was an unnecessary commitment of the larger right pulmonary circulation to the smaller blood volume of the superior vena caval return. With application of the Fontan principle to more complex cardiac malformations, there has been a reconsideration of possible benefits of a cavopulmonary shunt in selected patients. ⋯ After Fontan operation, six of seven patients tested also demonstrated bilateral distribution of atriopulmonary flow. We concluded from our experience that this modified shunt provides excellent relief of cyanosis, allows bidirectional pulmonary distribution of both superior vena caval return and also the right atrial blood flow after atriopulmonary connection, and may be done before, with, or after a Fontan procedure and is compatible with all currently recommended modifications. Perioperative hemodynamic adjustments to the Fontan procedure may be improved by reducing atrial volume, and this may also be of potential benefit in the long-term adaptation to Fontan physiology by minimizing atrial distention.
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J. Thorac. Cardiovasc. Surg. · Aug 1985
Randomized Controlled Trial Clinical TrialThe effect of ventilation on systemic blood gases in the presence of left ventricular ejection during cardiopulmonary bypass.
The effect of pulmonary ventilation upon systemic arterial blood gases during cardiopulmonary bypass in the presence of left ventricular ejection was evaluated in 20 adult male patients undergoing coronary artery bypass grafting. Following rewarming, establishment of a sinus rhythm, and production of a pulse pressure of at least 20 mm Hg on the arterial pressure trace caused by left ventricular ejection, arterial blood gases were obtained from the arterial and venous extracorporeal circuits and the radial arterial cannula. Patients were then randomly assigned to a nonventilation (n = 10) or a ventilation (n = 10) group. ⋯ Significant findings (p less than 0.05) included decreases in systemic carbon dioxide tension and increases in systemic pH in the ventilation group and decreases in systemic oxygen tension in the nonventilation group. Although the changes in the arterial blood gases were significant, these changes occurred well within the limits of clinical acceptability. It is concluded that left ventricular ejection for short periods during full cardiopulmonary bypass does not necessitate pulmonary ventilation.
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J. Thorac. Cardiovasc. Surg. · Aug 1985
Right ventricular dysfunction following cold potassium cardioplegia.
Right coronary artery stenoses limit cardioplegic delivery to the right ventricle and may contribute to postoperative right ventricular dysfunction. Right ventricular function was evaluated in 39 patients with right coronary artery stenoses following elective coronary bypass operations. Hemodynamic and nuclear ventriculographic measurements, made between 3 and 6 hours postoperatively, revealed a progressive increase in pulmonary arterial pressure, pulse rate, and right ventricular ejection fraction (p less than 0.05). ⋯ Right ventricular diastolic function (the relation between right atrial pressure and right ventricular end-diastolic volume index) and left ventricular diastolic function (the relation between left atrial pressure and left ventricular end-diastolic volume index) were significantly greater LATE than EARLY. Right, but not left, ventricular performance and systolic function were transiently depressed, and right and left ventricular diastolic stiffness were transiently decreased in the EARLY postoperative period. In patients with right coronary artery stenoses, current methods of cardioplegia may inadequately protect the right ventricle, but further studies are required to establish the relation between intraoperative protection and postoperative function.