The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Aprotinin modulation of platelet activation in patients undergoing cardiopulmonary bypass operations.
Aprotinin significantly decreases postoperative blood loss, yet its exact mechanism of action remains unproven. ⋯ This study demonstrates that in the presence of aprotinin, platelets remain unstimulated during CPB and the von Willebrand GPIb-mediated activatability of platelets is preserved, thus maintaining a viable platelet population. Most important, this study reveals that these mechanisms are more related to platelet-leukocyte than to platelet-platelet interactions.
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Randomized Controlled Trial Clinical Trial
Intraoperative autotransfusion reduces blood loss after cardiopulmonary bypass.
A combination of several techniques is necessary to minimize the transfusion requirements for open heart operations. The benefit of plasmapheresis remains in doubt because of smaller and less effective platelets obtained with this technique. Therefore, we evaluated the effects of whole blood intraoperative autotransfusion as part of a blood conservation protocol. ⋯ Autotransfusion during cardiopulmonary bypass provides benefit in addition to other techniques in reducing blood loss and the need for blood products in the postoperative period.
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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.
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Randomized Controlled Trial Clinical Trial
Effects of cardiopulmonary bypass temperature on pulmonary gas exchange after coronary artery operations.
Pulmonary dysfunction is one aspect of the postoperative morbidity associated with cardiopulmonary bypass. Normothermic systemic perfusion can result in shorter intubation times, which have been attributed to improved pulmonary gas exchange, but the influence of perfusion temperature on pulmonary gas exchange itself is not known. ⋯ Cardiopulmonary bypass perfusion temperature does not influence alveolar-arterial oxygen pressure gradients in the first 12 hours after routine coronary artery bypass grafting in patients with uncompromised pulmonary and left ventricular function.
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Randomized Controlled Trial Clinical Trial
Cardiopulmonary bypass temperature, hematocrit, and cerebral oxygen delivery in humans.
The neurologic effects of warm heart operations is a subject of popular interest. The purpose of this study was to examine the adequacy of cerebral oxygenation during normothermic cardiopulmonary bypass and better define the relationship between hematocrit, temperature, and brain oxygen delivery. ⋯ From the standpoint of global cerebral perfusion and oxygenation, our data support the practice of "warm" heart operations. It clarifies the marked influence of hematocrit on cerebral blood flow and delineates the interaction of temperature and hematocrit on cerebral oxygen delivery. It also suggests that additional investigation to better define "temperature-appropriate" hemodilution during cardiopulmonary bypass is indicated.