The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Disparity in blood activation by two different heparin-coated cardiopulmonary bypass systems.
Several studies have indicated reduced "blood activation" in heparin-coated cardiopulmonary bypass systems. The present study compares the effect of two different heparin coatings on different blood activation indices. ⋯ Both heparin coatings reduce blood activation, probably more so with Carmeda Biological Active Surface than with Duraflo II.
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Randomized Controlled Trial Clinical Trial
Completely heparinized cardiopulmonary bypass and reduced systemic heparin: clinical and hemostatic effects.
When heparinized circuits are used for cardiopulmonary bypass, the amounts of heparin and protamine administered systemically can be reduced. However, it is not entirely known what effects this reduction in systemic anticoagulation has on clinical performance and on the coagulation and fibrinolytic systems. ⋯ The combination of complete heparin-coated cardiopulmonary bypass circuits and low systemic heparinization is safe for patients undergoing elective coronary artery bypass procedures and reduces the perioperative blood loss. There was no evidence of increased thrombogenicity, fibrinolytic activity, or consumption of coagulation factors. No clinical or technical side effects were observed.
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Randomized Controlled Trial Clinical Trial
Cardiopulmonary bypass perfusion temperature does not influence perioperative renal function.
The recent introduction of normothermic cardiopulmonary bypass (CPB) perfusion has raised concerns regarding the associated risk of renal dysfunction through its potential to exacerbate the systemic inflammatory response and end-organ injury. This study was designed to investigate the influence of CPB perfusion temperature on renal function. ⋯ These data suggest that cardiopulmonary bypass perfusion temperature does not influence renal function in patients undergoing coronary artery bypass grafting.
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Randomized Controlled Trial Clinical Trial
Pretreatment with antioxidants and allopurinol diminishes cardiac onset events in coronary artery bypass grafting.
Oxygen-derived free radicals constitute one part of the etiologic factors for cardiac onset harmful events. Allopurinol is able to reduce the generation of free radicals. Vitamins E and C scavenge radicals after their formation. ⋯ Group 3 had fewer perioperative infarctions and less creatine kinase-MB release than the respective controls (group 4). Plasma levels of vitamins E and C, urate, and total free radical trapping ability were considered to support the theory about the role of free radicals in reperfusion injury. Especially the unstable patients, but also patients with stable coronary artery disease requiring coronary artery bypass grafting benefit from perioperative allopurinol and vitamin E and C treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cerebral blood flow during cardiac operations: comparison of Kety-Schmidt and xenon-133 clearance methods.
This study simultaneously compared the standard Kety-Schmidt and the modified xenon-133 (133Xe) clearance techniques for measuring cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) during cardiac operations. The validity of the CBF method is important because our management of the patient during cardiopulmonary bypass (CPB) is based, in part, on our understanding of the cerebral hemodynamics during CPB. In 20 patients undergoing coronary artery bypass grafting, CBF and CMRO2 were determined by both methods. ⋯ The modified 133Xe technique as typically used during cardiac operations does not appear to measure CBF accurately; this leads to corresponding errors in CMRO2 calculations. Determination of CMRO2 and cerebral autoregulatory function during cardiac operations appears to be more appropriate if based on the more direct Kety-Schmidt technique. Accordingly, our management of CPB with respect to cerebral perfusion as it has been determined by the modified 133Xe clearance method may require reassessment.