The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialStenosis of the right coronary artery and retrograde cardioplegia predispose patients to atrial fibrillation after coronary artery bypass grafting.
It is assumed that stenosis of the right coronary artery (RCA) predisposes CABG patients, by way of incomplete atrial myocardial protection, to postoperative atrial fibrillation (AF). Sixty patients with high-grade RCA lesion were randomized into four groups according to the technique of delivery of cold blood cardioplegia: antegrade, retrograde, retrograde without catheter cuff, and combined antegrade and retrograde. As controls, 34 patients without RCA lesion were randomized to receive antegrade or retrograde cardioplegia. ⋯ Prolonged stay in the intensive care unit (p < 0.001) and occurrence of postoperative ventricular tachycardia (p < 0.05) were associated with AF. RCA stenosis and retrograde cardioplegia delivery in RCA-affected patients were risk factors for postoperative atrial fibrillation. Retrograde cardioplegia may offer poorer protection at the atrial level.
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Thorac Cardiovasc Surg · Jun 1998
ReviewNear-infrared spectrophotometry of the brain in cardiovascular surgery.
Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac operations and are thought to be caused by embolism and cerebral hypoxia. Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. Different devices provide information on changes of oxygenated (HbO2) and deoxygenated hemoglobin (Hb), oxidized cytochrome aa3 (CytOx) or regional oxygen saturation (rSO2). ⋯ Therefore, the CytOx signal is of great interest for future studies. NIRS must prove its ability to diagnose cerebral hypoxia consistently during cardiac surgery in a large patient study before this method is brought into routine clinical practice. Absolute quantification and definitions of critical oxygenation margins will be helpful for this goal.
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Thorac Cardiovasc Surg · Jun 1998
Case ReportsChronic herniation of the lung in a patient with chronic obstructive pulmonary disease. Case report and review of the literature.
Lung herniation is a rare condition and can be classified by both anatomical site and etiology. A 70-year-old man was referred with dyspnea, productive cough, and right-sided chest pain. ⋯ Two years after surgical repair the patient is free of complaints. Treatment can be conservative or surgical, but as experience is limited no long-term results have been reported.
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Thorac Cardiovasc Surg · Apr 1998
Percutaneous dilatational tracheostomy done early after cardiac surgery--outcome and incidence of mediastinitis.
During November 95 to April 97, 45 percutaneous dilatational tracheostomies were performed in a nonselected patient series of 2788 open cardiac surgery cases. Tracheostomy was performed as early as the 2nd postoperative day (median: 6th day), when extubation was not foreseen within the next few days. Duration of intubation was 13 days (mean). ⋯ Clinically evident tracheal stenosis and inadequate granulation of the stoma were not observed after extubation. In our opinion, percutaneous dilatational tracheostomy is justifiable, shows good results, and entails minimal risk if done early after cardiac surgery, and it is also superior to standard surgical tracheostomy. Increased incidence of mediastinitis was not seen.
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Thorac Cardiovasc Surg · Feb 1998
Randomized Controlled Trial Clinical TrialPreconditioning enhances myocardial protection in patients undergoing open heart surgery.
To date, ischemic preconditioning is regarded as the most powerful form of endogenous myocardial protection. For the purpose of surgical myocardial protection, a few clinical studies have investigated the effects of ischemic preconditioning in conjunction with hypothermia or blood cardioplegia during open heart surgery, but the results were controversial. We now tested the hypothesis that preconditioning improves myocardial protection in patients undergoing cold crystalloid cardioplegic arrest. 36 patients needing mitral prosthetic valve replacement for rheumatic heart disease were studied. ⋯ The results indicated that there was a significant reduction of ST-segment shifting (ST-segment elevation, 0.07 +/- 0.02 vs 0.22 +/- 0.07 mV, p < 0.05, at 4 hours post reperfusion) and smaller release of creatine kinase-MB (87 +/- 11.5 vs 143 +/- 17.2 IU/L, p < 0.05, at 12 hours post reperfusion) in the preconditioning group. Preconditioning also enhanced myocardial contractility (dp/dtmax = 1490 +/- 75 vs 1280 +/- 88 mmHg/sec, at 30 minutes post reperfusion, p < 0.05) and promoted early postoperative recovery. The present study suggests that ischemic preconditioning reduces ischemia-reperfusion injury in human hearts even when combined with cold crystalloid cardioplegia.