The Annals of thoracic surgery
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Multicenter Study Clinical Trial
Anaerobic metabolism during cardiopulmonary bypass: predictive value of carbon dioxide derived parameters.
Hyperlactatemia during cardiopulmonary bypass (CPB) is a common event and is associated to a high morbidity and mortality after cardiac operations. The present study is aimed to identify the possible predictors of hyperlactatemia during CPB among a series of oxygen and carbon dioxide derived parameters measured during CPB. ⋯ Carbon dioxide derived parameters are representative of hyperlactatemia during CPB, as a result of the carbon dioxide produced under anaerobic conditions through the buffering of protons by the bicarbonate system. The carbon dioxide elimination rate measured at the exhaled site of the oxygenator may be used for an indirect assessment of the metabolic state of the patient.
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Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. ⋯ Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.
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Randomized Controlled Trial Comparative Study
Neurocognitive outcomes in off-pump versus on-pump bypass surgery: a randomized controlled trial.
Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass. However, the cognitive benefit of off-pump surgery remains unclear. ⋯ The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes.
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Comparative Study
Reduced atrial fibrillation in patients immediately extubated after off-pump coronary artery bypass grafting.
We analyzed data from patients undergoing off-pump isolated coronary artery bypass grafting surgery (OPCABG) to determine if immediate extubation in the operating room affected the incidence of postoperative atrial fibrillation. ⋯ Immediate extubation after OPCABG appears to reduce the incidence of postoperative atrial fibrillation independent of comorbidities.