The Annals of thoracic surgery
-
Multicenter Study
Decreasing mortality for aortic and mitral valve surgery in Northern New England. Northern New England Cardiovascular Disease Study Group.
Although numerous reports have documented declining mortality rates associated with coronary artery bypass surgery in recent years, it is unknown whether similar trends have occurred with valve surgery during this time. ⋯ Significant improvement in mortality rates with valve replacement was observed in northern New England during this time period. This improvement persisted following adjustment for changes in patient casemix over this time. These trends mirror improvements in mortality with other cardiac surgical interventions that have been observed in recent years in our region and nationally.
-
A variety of measures may affect bleeding and transfusion requirements in abciximab-treated patients. These measures include recognition of the risk factors for increased bleeding and transfusion requirements, use of proper transfusion practices, conservation or increasing of red cell mass, appropriate heparin dosing and protamine reversal, reversal of anticoagulation, awareness of factors that affect activated clotting time (ACT), and appropriate anticoagulation for cardiopulmonary bypass.
-
Randomized Controlled Trial Clinical Trial
Is adenosine preconditioning truly cardioprotective in coronary artery bypass surgery?
The large number of experimental studies showing that adenosine "turns on" the protein kinase C (PKC)-mediated pathway that accounts for the cardioprotection conferred by ischemic preconditioning contrasts with the scarcity of clinical data documenting the preconditioning-like protective effect of adenosine during cardiac operations on humans. ⋯ Adenosine, given at a clinically safe dose, can turn on the PKC-mediated signaling pathway involved in preconditioning but this biochemical event does not translate into reduced cell necrosis after coronary artery surgery, suggesting that a preconditioning-like protocol may not be the best suited for exploiting the otherwise well-documented cardioprotective effetcs of adenosine.
-
The efficacy of preoperative intraaortic balloon pump therapy in high-risk coronary patients has been demonstrated earlier. ⋯ Preoperative intraaortic balloon pump therapy in high risk coronary patients is significantly cost-beneficial, With an average saving of 24,000 Swiss francs ($16,000) on the total hospital cost, a 36% cost reduction.
-
The presence of a tracheal stoma in patients with previous total laryngectomy who require cardiac operations is associated with an increased risk of wound complications and tracheal injuries when a full sternotomy is used. The aim of this report is to describe a technique of manubrium-sparing sternotomy, which can be used in patients undergoing coronary artery bypass grafting without cardiopulmonary bypass.