The Annals of thoracic surgery
-
Little is known about the incidence, indications, and results of surgical repair or replacement of the aortic valve after balloon aortic valvuloplasty (BAV) for congenital aortic stenosis in children. This study was designed to evaluate patterns of failure requiring operation after BAV for congenital aortic stenosis and to review our experience with successful repair, rather than replacement, of selected aortic valves after BAV. ⋯ Aortic valve operation is required in 5% to 7% of patients yearly after BAV. The need for operation appears to be unrelated to age at the time of BAV; aortic insufficiency predominates over aortic stenosis as an indication for operative intervention. Valve repair can be applied in some patients after BAV with good intermediate-term results and may delay the need for aortic valve replacement.
-
Na+/H+ exchange represents an important mechanism for pH regulation in the cardiac cell that, however, may paradoxically mediate tissue damage in the reperfused myocardium. We investigated whether inhibition of the exchanger can protect the heart against damage after prolonged hypothermic storage with the use of the selective inhibitor 3-methylsulfonyl-4-piperidinobenzoyl-guanidine methanesulfonate (HOE 694). ⋯ This study shows a marked protective effect of the Na+/H+ exchange inhibitor HOE 694 in rabbit hearts subjected to 12 hours of hypothermic ischemia and strongly suggests that antiport inhibitors could play an effective role in myocardial preservation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Tranexamic acid reduces postbypass blood use: a double-blinded, prospective, randomized study of 210 patients.
Pharmacologic intervention to minimize postbypass bleeding and blood product transfusions has received increasing attention for both medical and economic reasons. ⋯ Tranexamic acid is safe and effective in reducing blood loss and blood use in a wide variety of cardiac surgical patients.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Autotransfusion after coronary artery bypass grafting halves the number of patients needing blood transfusion.
Several randomized studies about autotransfusion of shed mediastinal blood in patients undergoing coronary artery bypass grafting have resulted in divergent findings concerning reduction of the need for homologous blood transfusions. Most of these studies used less strict criteria for homologous blood transfusion than applied in daily clinical practice. ⋯ Autotransfusion of shed mediastinal blood in patients undergoing elective, uncomplicated coronary artery bypass grafting halves the number of patients needing homologous blood and reduces the amount of homologous blood given.