Circulation
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Clinical Trial
Effect of aging on cerebral autoregulation during cardiopulmonary bypass. Association with postoperative cognitive dysfunction.
Age is a predictor of cognitive dysfunction after cardiac surgery, but the mechanism is unknown. The purpose of our study was to determine whether age-related decrements in cognition are associated with cerebral blood flow (CBF) autoregulation during cardiopulmonary bypass (CPB). ⋯ Increased age predisposes to impaired cognition after cardiac surgery. This decline in cognitive function in the elderly is not associated with age-related changes in cerebral blood flow autoregulation. The association of increased oxygen extraction with decline in some measures of cognitive function suggests that an imbalance in cerebral tissue oxygen supply, which is unrelated to age, contributes to acute cognitive dysfunction after cardiac surgery. Cognitive dysfunction after CPB in the elderly cannot be explained by impaired CBF autoregulation.
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Comparative Study Clinical Trial Controlled Clinical Trial
Patency of internal thoracic artery grafts: comparison of right versus left and importance of vessel grafted.
The early and late patency of the left internal thoracic artery (LITA) has been studied thoroughly, but less is known about coronary artery bypass grafts constructed from the right internal thoracic artery (RITA). ⋯ This study supports the continued use of the RITA as a conduit for coronary artery revascularization. In our experience, the position of the target vessel is a more important determinant of graft patency than the side of the internal thoracic artery selected for use as a bypass graft.
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Aortic valve surgery for endocarditis remains a high-risk procedure. The objective of this study was to analyze the interaction between the various subsets of endocarditis (native, prosthetic, healed, and active), timing of surgery, and their influence on early and late outcomes. ⋯ These data suggest that for active endocarditis, surgery should be delayed to achieve a healed status provided there is no pressing need for immediate surgery. Patients with staphylococcal endocarditis, particularly on a prosthesis, should be operated on sooner and should be covered with antibiotics for an extended period to prevent recurrent PVE. This study stresses the need for aggressive antibiotic prophylaxis, particularly in the presence of a prosthesis.
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Comparative Study
Emergency cardiopulmonary bypass in the cardiac surgical unit can be a lifesaving measure in postoperative cardiac arrest.
Postoperative cardiac arrest that is not responsive to conventional resuscitation is uniformly fatal. Sixteen patients who experienced postoperative ventricular fibrillation (VF) and arrest over a 6-year period and did not respond to open chest resuscitation were placed on an emergency basis on cardiopulmonary bypass (CPB) in the cardiac surgical intensive care unit (CSICU). ⋯ The use of CPB in the CSICU can achieve significant survival in patients who have otherwise irreversible cardiac arrest and/or VF after surgery; the incidence of infection in patients undergoing CPB in the CSICU is very low; and the use of warm cardioplegic arrest may enhance the changes of survival in this type of patient.
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Comparative Study Clinical Trial Controlled Clinical Trial
Metabolic and functional evidence that retrograde warm blood cardioplegia does not injure the right ventricle in human beings.
Retrograde warm blood cardioplegia is now recognized as an effective method of myocardial protection, but concerns persist about its ability to adequately preserve the right ventricle. ⋯ Inadequate protection of the right ventricle associated with the use of retrograde warm blood cardioplegia does not appear to be a clinically founded concern since this technique preserves right ventricular function to the same extent as conventional antegrade cold cardioplegia does.