The Annals of thoracic surgery
-
Diabetes mellitus is an established independent risk factor for significant morbidity and mortality after coronary artery bypass grafting. ⋯ Diabetics have a worse hospital and longterm outcome after coronary artery bypass grafting. The increased risk in such patients can only partially be explained by other demographic characteristics.
-
The Society of Thoracic Surgeons National Database Committee is committed to risk stratification and assessment as integral elements in the practice of cardiac operations. The National Cardiac Surgery Database was created to analyze data from subscribing institutions across the country. We analyzed the database for valve replacement procedures with and without coronary artery bypass grafting to determine trends in risk stratification. ⋯ Risk modeling is a valuable tool for predicting the probability of operative death in any individual patient. This large, multiinstitutional database is capable of determining modern operative risk and should provide standards for acceptable care. The study illustrates the importance of risk stratification for early death both for the patient and the surgeon.
-
Chronic pulmonary hypertension can lead to compensatory changes in the right ventricle. In this study, the adaptive mechanisms of the right ventricle in the setting of pulmonary hypertension were assessed at the molecular and functional level using a canine model of monocrotaline pyrrole-induced pulmonary hypertension. ⋯ These data suggest that alterations in right ventricular function in the setting of chronic pulmonary hypertension may partially be due to changes in myocardial adrenergic receptor signaling.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Pain control after thoracotomy: bupivacaine versus lidocaine in continuous extrapleural intercostal nerve blockade.
The use of a continuous bupivacaine extrapleural intercostal nerve block after posterolateral thoracotomy has been shown in randomized controlled studies to be effective in reducing postoperative pain and restoring pulmonary function. It is our hypothesis that when using a continuous infusion for nerve block, a long-acting agent (bupivacaine) is unnecessary and a shorter-acting agent (lidocaine) would offer equivalent results with less systemic toxicity. This study was designed to determine whether lidocaine was as effective as bupivacaine in a continuous extrapleural intercostal nerve block after posterolateral thoracotomy because lidocaine is a less toxic analgesic agent. The study was prospectively randomized and double-blinded. ⋯ Lidocaine offers equivalent pain control to bupivacaine when administered for continuous extrapleural intercostal nerve block after posterolateral thoracotomy, with less risk of systemic toxicity.
-
The use of the intraaortic balloon pump (IABP) in patients undergoing coronary artery bypass grafting has been traditionally associated with a high complication rate and adverse outcomes. However, recent reports show that many of these catastrophic outcomes can be avoided by preoperatively placing the IABP in high-risk patients. To further validate these reports, we defined a set of liberal criteria for preoperative IABP insertion and applied them to a series of elderly patients (70 years or older) undergoing isolated coronary artery bypass grafting. ⋯ Liberal preoperative insertion of the IABP can be performed safely in high-risk elderly patients undergoing coronary artery bypass grafting, with results comparable to those in lower risk patients.