The Annals of thoracic surgery
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Comparative Study
Off-pump multivessel coronary artery surgery in high-risk patients.
Coronary artery bypass surgery on cardiopulmonary bypass is associated with significant morbidity and mortality, which may be more marked in high-risk patients. We evaluated our results of off-pump coronary artery bypass (OPCAB) in high-risk patients with multivessel coronary artery disease and compared them with results in similar patients who underwent operation on cardiopulmonary bypass. ⋯ Off-pump coronary artery surgery can be safely performed in high-risk patients with multivessel coronary artery disease. Operative mortality is comparable to that associated with on-pump surgery, and avoidance of cardiopulmonary bypass is associated with reduced postoperative morbidity in these patients.
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Comparative Study
Is it safe to train residents to perform cardiac surgery?
The impact of surgical training on patient outcomes in cardiac surgery is unknown. ⋯ In this analysis of our experience with residency training, the operative morbidity and mortality in CABG and AVR patients was similar for residents and staff. Training residents to perform cardiac surgery appears to be safe.
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Comparative Study
A retrospective review of three antibiotic prophylaxis regimens for pediatric cardiac surgical patients.
Optimal antimicrobial prophylaxis for the pediatric cardiac surgical patient is unknown. We have reviewed our experience with more than 4,000 pediatric cardiac surgical patients at the University of Michigan to evaluate antibiotic prophylaxis regimens. ⋯ These data suggest that pediatric cardiac surgical patients may benefit from prophylactic antibiotics as long as thoracostomy tubes are in place.
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Comparative Study
PulseCO: a less-invasive method to monitor cardiac output from arterial pressure after cardiac surgery.
Cardiac output is often monitored after cardiac operations with a pulmonary artery catheter. A new method has been introduced that measures cardiac output by lithium dilution (LiDCO) and uses these data to calibrate a system (PulseCO) that calculates cardiac output continuously from the energy of the arterial pressure waveform. It is unknown whether PulseCO measurements are valid early after cardiac surgery when changes in temperature and vascular tone or intermittent use of the arterial line for blood sampling may occur. This study assessed the reliability of cardiac output determinations by PulseCO in the first 8 hours after cardiac surgery. ⋯ PulseCO measurements remain reliable without recalibration for at least 8 hours after cardiac surgery and may offer a less-invasive approach for early postoperative cardiac output monitoring.
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Neutrophil activation is implicated in postoperative complications in patients having cardiac surgery with cardiopulmonary bypass (CPB). This study was designed to determine the temporal fluctuations in the primability of neutrophils in the preoperative, intraoperative, and postoperative periods of CPB, and specifically whether CPB was a primary cause leading to increased neutrophil priming and elastase release. ⋯ Our data suggest that neutrophil priming occurs early before commencing CPB in cardiac surgical patients, and that CPB is not the primary primer. Anesthesia, surgical trauma, and other events may have been involved in neutrophil priming and sensitization before CPB, which warrants further investigation.