The Annals of thoracic surgery
-
Two types of ventricular assist systems have been approved for use by the Japanese government. ⋯ From these data, the Toyobo pump and the Zeon pump are useful for short-term support for acute, profound heart failure. The Toyobo pump also may provide sufficient support as a bridge to transplantation for the medium term.
-
Recent changes in health care financing have raised the specter of operation-specific, volume credentialing for cardiac surgeons. To meet this challenge, the leadership of The Society of Thoracic Surgeons formed an Ad Hoc Committee to study the question of the relationship of case volume to outcome. One product of the committee's work in this analysis of data from The Society of Thoracic Surgery National Cardiac Database. ⋯ Although the data are practice-group-specific only, there was no clinically relevant correlation of volume to outcome except at extremely low annual volume (less than 100 cases per year). Variability of outcome was significant in lower volume practices (less than 600 cases/year) and varied little at more than 600 cases per year. There were no differences in expected mortality regardless of the size of the practice.
-
Controversy still exists as to whether patients with previous stroke are at increased risk for neurologic complications after heart operations. ⋯ This analysis identifies a group of patients at high risk for neurologic sequelae and confirms the vulnerability of the previously injured brain to cardiopulmonary bypass, as evidenced by reappearance or exacerbation of focal deficits in such patients.
-
The cardiopathic patient can sustain acute heart failure during pregnancy. In such cases, if open heart operation is necessary to save the patient's life, the fetus could be seriously compromised after exposure to cardiopulmonary bypass. From 1958 to 1992, 69 reports of cardiac operations during pregnancy with the aid of cardiopulmonary bypass have been published. ⋯ Hypothermia decreases O2 exchange through the placenta. Pump flow and mean arterial pressure during cardiopulmonary bypass seem to be the most important parameters that influence fetal oxygenation. We speculate that cardiac operation is not a contraindication to pregnancy prolongation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Randomized study of right ventricular function with intermittent warm or cold cardioplegia.
Transient right ventricular dysfunction has been previously documented after bypass operations despite adequate myocardial protection with intermittent antegrade cold blood cardioplegia. Recently warm blood cardioplegia has been interrupted during construction of distal anastomoses to improve visualization. The effects of intermittent antegrade warm blood cardioplegia, and the resultant periods of right ventricular normothermic ischemia, on postoperative right ventricular function are unknown. ⋯ Despite intermittent normothermic ischemia of half the cross-clamp time, patients receiving warm cardioplegia maintained right ventricular hemodynamics after bypass grafting.