The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1979
Use of athrombogenic tubing for perfusion rewarming following surface-induced deep hypothermia.
A method of heparinless, oxygenatorless, left heart bypass perfusion rewarming following surface hypothermia, with the use of a closed circuit with 130 ml. prime volume including heat exchanger, has been devised. The use of polyurethane-polyvinyl-graphite (PPG)-coated tubing has previously been reported. In this text, the use of an athrombogenic coating with cetyl-pyridinium chloride (CPC) as a regional heparin carrier was studied in dogs, comparing groups with PPG tubing and total systemic heparinization or plain polyvinyl tubing without systemic heparinization. ⋯ Alterations of hematologic parameters in all three groups were similar to those during surface rewarming except for those affected by heparinization. The left heart bypass method was found useful for hypothermic open-heart surgery when utilized with an athrombogenic surface coating or total body heparinization. It was concluded that the CPC coating is superior to the PPG coating since no cracking surface develops, it is translucent, and it provides a more effective athrombogenic surface.
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J. Thorac. Cardiovasc. Surg. · Dec 1978
Comparative StudyNon--cloth-covered caged-ball prostheses. The second decade.
The Starr-Edwards Models 6120 mitral and 1200/60 aortic valves are caged-ball prostheses with cloth-covered sewing rings and bare-metal struts. Introduced in 1965, they have been in continuous clinical use longer than any other currently available heart valve prostheses. Late results with this valve are analyzed and compared with recent series employing other current valve prostheses. ⋯ There was one anticoagulant-related death in 1,698 patient-years of follow-up. The current non--cloth-covered caged-ball valves provide unquestionable durability and well-documented results into their second decade of use. They provide a base line for comparison with newer prostheses and offer a valid, current choice for both aortic and mitral valve replacement.
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The role of angiography in cervicothoracic trauma is controversial. Since 1967 the policy at San Francisco General Hospital has been to use liberal indications for angiography in hemodynamically stable patients with either penetrating or blunt cervicothoracic trauma. The 304 patients in Group 1 had emergency angiographic evaluation: 102 had penetrating cervical wounds: 202 had thoracic injuries-71 penetrating and 131 blunt trauma. ⋯ Angiographic results were useful whether abnormal or normal. In cases with adnormal findings operative treatment was specific and improper incisions were avoided. In cases with normal angiographic results, clarification of the vascular status avoided unnecessary operations and permitted concentration of therapeutic effort upon the main clinical problems of the patients.
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J. Thorac. Cardiovasc. Surg. · Nov 1978
Physicians' assistants on a university cardiothoracic surgical service. A five-year update.
In 1973 two physicans' assistants (P. A.'s) were employed on a cardiothoracic surgical service at Emory University Hospital. In 1974 our initial experience with these paramedical personnel was presented to this Association. ⋯ This report details our experience with P. A.'s for the past 5 years--culminating in a staff of ten P. A.'s working on our service in four types of hospitals within our university medical center.
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J. Thorac. Cardiovasc. Surg. · Nov 1978
Postperfusion lung syndrome. Comparison of Travenol bubble and membrane oxygenators.
To examine the role of the oxygenator in the postperfusion lung syndrome, we studied 16 patients undergoing aorta-coronary bypass with a bubble oxygenator and 14 similar patients with a membrane oxygenator both before and for 2 days after the operation. To maintain the same pulmonary artery occluded pressure and hemoglobin level at the end of the surgical procedure, significantly more blood was required in the bubble than in the membrane group. Postoperative pulmonary dysfunction in the bubble group was characterized by increased pulmonary vascular resistance (PVR) and lung water. ⋯ The bubble group had a significantly greater increase in PVR at the immediate postoperative study time than did the membrane group. PVR returned to control value for the duration of study. These differences in lung water and PVR measurements may be related to greater blood component trauma with a Travenol bubble oxygenator than with a membrane lung.