The Annals of thoracic surgery
-
Pulmonary ventricle to pulmonary artery conduits have made repairing many complex congenital cardiac anomalies possible. Late patient outcome is adversely affected by the hemodynamic consequences of conduit failure and the need for reoperation for conduit replacement. ⋯ The peel operation simplifies conduit replacement, can be performed with low risk, and provides a generous-sized flow pathway. In our experience late results demonstrate a lower freedom from reoperation than conventional prosthetic or homograft conduits.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Bivalirudin versus heparin and protamine in off-pump coronary artery bypass surgery.
Bivalirudin is a short-acting direct thrombin inhibitor, with advantages over unfractionated heparin for anticoagulation in cardiac surgery. We hypothesized that bivalirudin is not associated with a clinically important increase in blood loss compared with heparin with protamine reversal in patients undergoing off pump coronary artery bypass (OPCAB) surgery. We also assessed flow with angiography at 3 months using a modified Thombolysis in Myocardial Infarction (TIMI) grade in the grafted coronary arteries. ⋯ Anticoagulation for OPCAB surgery with bivalirudin was feasible without a clinically important increase in perioperative blood loss. Graft flow was better in the bivalirudin patients; the impact of this on clinical outcomes requires a larger study.
-
Randomized Controlled Trial Clinical Trial
Lung perfusion with protective solution relieves lung injury in corrections of Tetralogy of Fallot.
The aim of this study was to evaluate the protective effect of pulmonary perfusion with hypothermic protective solution on lung function after cardiopulmonary bypass in corrections of Tetralogy of Fallot. ⋯ Lung perfusion with hypothermic protective solution during cardiopulmonary bypass relieved lung injury in corrections of Tetralogy of Fallot. The inhibition of lung vascular endothelial cell injury may be the major mechanism of relieving cardiopulmonary bypass-induced lung injury.
-
Randomized Controlled Trial Clinical Trial
Fresh frozen plasma in the pediatric pump prime: a prospective, randomized trial.
The aim of this study was to determine whether the use of fresh frozen plasma (FFP) in the infant pump prime can avoid dilution of fibrinogen, decrease the need for blood product transfusion after bypass, and decrease exposure to donor blood products. ⋯ The use of FFP in the pump prime significantly limited dilutional hypofibrinogenemia, decreased the transfusion of cryoprecipitate after bypass, and tended to decrease the overall mean patient exposure to blood products.
-
While early extubation after coronary artery bypass grafting (CABG) has been associated with resource savings, its effect on patient outcomes remains unclear. The goal of the present investigation was to evaluate whether early extubation can be performed safely in elderly CABG patients in community practice. ⋯ In community practice, early extubation after CABG can be achieved safely in selected elderly patients. This practice was associated with shorter hospital stays without adverse impact on postoperative outcomes.