The Annals of thoracic surgery
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Reperfusion injury is a significant cause of early allograft dysfunction after lung transplantation. We hypothesized that direct pulmonary arterial infusion of an intravascular nitric oxide donor, sodium nitroprusside (SNP), would ameliorate pulmonary reperfusion injury more effectively than inhaled nitric oxide without causing profound systemic hypotension. ⋯ Pulmonary arterial infusion of low-dose SNP during lung reperfusion significantly improves pulmonary hemodynamics, oxygenation, compliance, and edema formation. These effects were achieved at doses of SNP that did not cause profound systemic hypotension. Direct intravascular infusion of SNP via pulmonary arterial catheters could potentially abate reperfusion injury immediately after allograft implantation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Normothermic retrograde blood cardioplegia with or without preceding ischemic preconditioning.
Preconditioning has been suggested as the most powerful mechanism of myocardial protection against prolonged ischemia. However, whether preconditioning offers additional benefits over cardioplegia during coronary artery bypass grafting is not known. ⋯ The results show that a 5-minute preconditioning ischemia does not offer any additional benefits over normothermic retrograde blood cardioplegia during coronary artery bypass grafting.
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Randomized Controlled Trial Clinical Trial
Endothelin-1 and neutrophil activation during heparin-coated cardiopulmonary bypass.
Heparin-coated circuits attenuate the systemic inflammatory response to cardiopulmonary bypass. The present study compares two different heparin coatings in terms of the release of endothelin-1 and neutrophil glycoproteins. ⋯ The plasma levels of endothelin-1, lactoferrin, and myeloperoxidase increase during cardiopulmonary bypass in coronary artery bypass grafting, but this has no clinical side effects in low-risk patients. The increase is attenuated using heparin-coated extracorporeal circuits, and then more effectively by Carmeda BioActive Surface than by Duraflo II.
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We studied whether negative inlet pressure created by a centrifugal pump during extracorporeal membrane oxygenation damages blood. ⋯ There were strong indications that reduction of negative pump inlet pressure with the servo regulator prevented hemolysis and kidney damage.
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Inhaled nitric oxide (NO) is a promising therapy that may be valuable in the control of pulmonary hypertension in cardiac surgical patients. Patients with valvular heart disease have remodeling of the pulmonary vascular bed that contributes to pulmonary hypertension. The purpose of this study was to compare the efficacy of inhaled NO in cardiac surgical patients with pulmonary hypertension with and without valvular heart disease. ⋯ Among cardiac surgical patients with pulmonary hypertension, the response to inhaled NO is variable. Despite the promise of inhaled NO as a pulmonary vasodilator in cardiac surgical patients, these data suggest that alternative therapies are needed to control pulmonary hypertension in patients with pulmonary hypertension from valvular heart disease.