The Annals of thoracic surgery
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We report a case of successful reimplantation of the right coronary artery from the pulmonary trunk into the aorta with a 10-year follow-up. The finding of a normal coronary flow reserve late after surgery suggests that direct reimplantation of the right coronary artery into the aorta is the preferable surgical technique.
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Comparative Study
pH-stat versus alpha-stat perfusion strategy during experimental hypothermic circulatory arrest: a microdialysis study.
The superiority of the pH-stat to the alpha-stat acid-base strategy during cardiopulmonary bypass as a neuroprotective method during hypothermic circulatory arrest is still controversial. In the present study, brain metabolism and outcome have been evaluated in a surviving model of experimental hypothermic circulatory arrest. ⋯ During cardiopulmonary bypass before and after a period of hypothermic circulatory arrest, acid-base management according to the pH-stat principles seemed to be associated with less derangements in cerebral metabolism, lower intracranial pressures, and excellent behavioral recovery and survival outcome. Because there is strong evidence of the beneficial metabolic effects related to this method, further studies using an experimental model of combined HCA and embolic brain injury are required to exclude a possible increased risk of cerebral embolism associated with the pH-stat strategy.
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Comparative Study
Protection of myocardium by cyclosporin A and insulin: in vitro simulated ischemia study in human myocardium.
The efficacy of myocardial protection by cyclosporin A (CSA) and insulin was tested in human right atrial myocardial slices subjected to simulated ischemia and reoxygenation. ⋯ Protection of right atrial trabeculae slices with insulin is superior to that obtained with CSA and is independent of preoperative medication.
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Comparative Study
Gender influence on cognitive function after cardiac operation.
Women are at higher risk than men for stroke after cardiac operation. The purpose of this study was to evaluate for gender influences on the more common postoperative neurologic complication, cognitive dysfunction. ⋯ These data suggest that, although the frequency of cognitive dysfunction after cardiac operation is similar for women and men, women appear more likely to suffer injury to brain areas subserving visuospatial processing. Risk factors for postoperative cognitive impairment vary depending on cognitive domain, suggesting multiple etiologies for this form of perioperative neurologic injury.
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The safety of cerebrospinal fluid (CSF) drainage in thoracic aortic surgery using extracorporeal circulation (ECC) with systemic heparinization has not been established. ⋯ The CSF drainage in thoracic aortic surgery using ECC with full anticoagulation did not result in hemorrhagic complications. The permanent paraplegia rate in this complex patient population consisting of combined distal arch, thoracoabdominal aortic procedures were low, and lumbar CSF catheter-related complications had no permanent sequelae.