The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of hypertonic saline-dextran solution in cardiac valve surgery with cardiopulmonary bypass.
Hypertonic saline-dextran (HSD) solution may be beneficial in patients undergoing coronary artery surgery with cardiopulmonary bypass. Valvular dysfunction is associated with high pulmonary wedge pressure, pulmonary hypertension, and ventricular dysfunction. Fluid overload or transient left ventricular failure may occur with HSD infusion in such patients. This study evaluates the cardiorespiratory effects and tolerance of HSD solution infusion in patients undergoing cardiac valve surgery. ⋯ The HSD solution infusion in patients during cardiac valve surgery with cardiopulmonary bypass was well tolerated. Hemodynamic and respiratory functions improved and fluid balance was near zero during the first 48 hours as compared with a large positive balance in the control group. We conclude that HSD infusion is advantageous for patients undergoing cardiac valve surgery.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery.
The discovery of nitric oxide as mediator in cardiac postoperative vasoplegia encourages the use of inhibitory drugs such as methylene blue. This drug has been used with favorable results in isolated cases. The purpose of this article is to analyze the incidence of the postoperative vasoplegic syndrome, to consider its prognosis, and to evaluate the effect of intravenous methylene blue on mortality. ⋯ Vasoplegic postoperative syndrome was seen in 8.8% of all patients. Outcome in patients with vasoplegia was worse with increased morbidity and mortality. The use of methylene blue reduced the high mortality in this population.
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Meta Analysis Comparative Study
Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients.
Several recent studies have highlighted the potential benefits of using off-pump coronary artery bypass (OPCAB) surgery, particularly in high-risk patients. The aim of this meta-analysis is to assess the effect of OPCAB on the incidence of stroke compared with coronary artery bypass grafting using cardiopulmonary bypass (CPB) in elderly patients. We performed a meta-analysis of all observational studies, published in MEDLINE between 1999 and 2002 and a comparison between the OPCAB and CPB techniques in elderly patients was performed with the outcome of interest being the incidence of stroke. ⋯ We did not identify any significant heterogeneity and funnel plot asymmetry between the studies included in the meta-analysis. Meta-regression analysis including variables predicting stroke, mortality, and study characteristics did not show any associations affecting the calculated odds ratio of stroke. Despite the fact that this is a meta-analysis of observational studies and adjustment for differences in baseline risk factors between OPCAB and CPB patients was not possible, we believe that this study suggests that the OPCAB technique might be associated with reduced incidence of stroke in the elderly patients undergoing coronary artery bypass grafting.
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A significant number of patients develop cognitive impairment that persists for months following coronary artery bypass grafting (CABG) surgery. Our objectives were to identify patient-related risk factors, processes of care, and the occurrence of any perioperative complications associated with cognitive decline. ⋯ Patients with noncoronary manifestations of atherosclerosis, chronic disabling neurologic illness, or limited social support are at risk for cognitive decline after CABG surgery. In contrast, more years of education were associated with less cognitive decline. Preoperative assessment of risk factors identified in this study may be useful when counseling patients about the risk for cognitive decline following CABG surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of nafamostat mesilate and minimal-dose aprotinin on blood-foreign surface interactions in cardiopulmonary bypass.
The pharmacological inhibition of blood-foreign surface interactions is an attractive strategy for reducing the morbidity associated with cardiopulmonary bypass. We compared the inhibitory effects of nafamostat mesilate (a broad-spectrum synthetic protease inhibitor) and minimal-dose aprotinin on blood-surface interactions in clinical cardiopulmonary bypass. ⋯ Nafamostat mesilate fails to reduce thrombin formation and neutrophil elastase release, whereas minimal-dose aprotinin inhibits both. Neither nafamostat nor aprotinin inhibits platelet activation. Nafamostat reduces fibrinolysis during cardiopulmonary bypass, although its effect is not as potent as aprotinin.