[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai
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Nihon Kyobu Geka Gakkai Zasshi · Nov 1996
[Emergent coronary bypass grafting after acute myocardial infarction].
In an attempt to examine various factors affecting the short- and long-term results of emergent coronary bypass graft surgery (ECABG) after an acute myocardial infarction (AMI), all patients undergoing ECABG without associated procedures at our institution from January 1987 to July 1995 were reviewed. Forty eight patients underwent ECABG after AMI. The hospital mortality rate was 20.8%. ⋯ Univariate comparison of survival curves and coronary event free curves showed that use of SVG alone was associated with decreased survival (p = 0.0009) and event free (p = 0.02) rates. Patients with non-Q-wave infarction and without cardiogenic shock may undergo ECABG relatively safely at any time. The use of internal thoracic artery at ECABG without cardiogenic shock does not increase hospital mortality and improves both long-term survival and freedom from coronary events.
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Nihon Kyobu Geka Gakkai Zasshi · Nov 1996
Comparative Study[Comparison of the protective prorerties of St. Thomas', Tyers', and Bretschneider's cardioplegic solutions in the neonatal rabbit heart].
Many studies suggest that single-dose and multidose cardioplegia are protective in the ischemic adult heart, but in the neonatal heart single-dose cardioplegia is only protective, whereas multidose cardioplegia is damaging. We examined three clinically used cardioplegic solutions to compare the protective properties of single-dose and multidose cardioplegia in the neonatal rabbit heart (aged 7 to 10 days). The clinical solution studied were St. ⋯ Among multidose groups, CVR prior to reperfusion was lowest in Breschneider's solution as well. In conclusions, these results confirmed that, using the clinical solutions studied, single-dose cardioplegia provided better functional recovery than multidose cardioplegia in the neonatal rabbit heart. However, low CVR in Bretschenider's multidose cardioplegia suggested the better protection in coronary vasculature although functional recovery was poor.
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Nihon Kyobu Geka Gakkai Zasshi · Nov 1996
[Emergency percutaneous cardiopulmonary support for patients with cardiac arrest or severe cardiogenic shock].
A total of 20 patients who developed cardiac arrest or severe cardiogenic shock were resuscitated with percutaneous cardiopulmonary support system (PCPS). The etiology of shock was acute myocardial infarction (n = 8), post-infarction left ventricular (LV) free wall rupture (n = 9) and others (n = 3). After successful resuscitation with PCPS, 17 patients underwent therapeutic interventions: either closure of an LV rupture (n = 9), coronary artery bypass grafting (n = 4), percutaneous transluminal angioplasty (n = 1) and percutaneous transluminal coronary recanalization (n = 1). ⋯ Nine patients survived longer than 30 days and 6 patients were discharged from the hospital. In nine patients with LV free wall rupture, one could be discharged from the hospital. Even though our experience is still small in number, it can be concluded that cardiopulmonary resuscitation using PCPS improves survival in fatally ill patients.
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Nihon Kyobu Geka Gakkai Zasshi · Nov 1996
Clinical Trial[Aprotinin reduces homologous blood transfusions when pediatric cardiac surgery must be redone].
The hemostatic effect of aprotinin in pediatric cardiac surgery is controversial. This study demonstrated the usefulness of aprotinin in cases undergoing additional surgery. In a retrospective study, three groups of children were investigated. ⋯ In group III, blood loss both 12 and 48 hours postoperatively were one-third less than those in group I (no significant difference). The use of homologous blood 48 hours postoperatively was significantly reduced in group III compared to that in group I (p < 0.01) or group II (p < 0.05). We conclude that aprotinin administration during cardiopulmonary bypass reduced blood loss and homologous blood requirements both operatively and postoperatively when pediatric cardiac surgery must be redone.
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Nihon Kyobu Geka Gakkai Zasshi · Nov 1996
Case Reports[Case report of coronary artery bypass grafting using only arterial grafts in a patient with idiopathic thrombocytopenic purpura].
The patient was a 76-year-old woman with angina, and diagnosed as idiopathic thrombocytopenic purpura (ITP) by preoperative blood examination. High-dose transvenous gamma-globulin (0.3 g/kg/day) therapy was subsequently conducted for 4 days before operation. ⋯ All grafts were patent and the postoperative course was satisfactory. Arterial grafts may thus be considered suitable for CABG in patients with ITP.