Perfusion
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Randomized Controlled Trial
Human albumin in extracorporeal prime: effect on platelet function and bleeding.
Synthetic starches have been positioned as an equivalent substitute for human albumin in extracorporeal prime, with both providing osmotic and oncotic pressure. Another effect of albumin is its ability to coat the synthetic surfaces of an extracorporeal circuit with a biopassivating protein monolayer. Whether this protein biopassivation has any benefit to the patient, assessed by platelet count, platelet function and 24-hour bleeding rate, is considered. ⋯ Human albumin can passivate the synthetic surfaces of the extracorporeal circuit, which is supported by observations of preserved platelet count and reduced chest tube drainage. Although some statistically significant benefits were observed, the practical benefits of passivating an extracorporeal circuit with human albumin may be minimal.
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Randomized Controlled Trial
Immediate effects of individualized heparin and protamine management on hemostatic activation and platelet function in adult patients undergoing cardiac surgery with tranexamic acid antifibrinolytic therapy.
This randomized prospective study was initiated to clarify whether individualized heparin and protamine dosing has immediate effects on hemostatic activation and platelet function in adult cardiac surgery. ⋯ An individualized and stable heparin concentration and appropriate dosing of protamine can reduce thrombin generation and preserve platelet function, even in short-time CPB.
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Randomized Controlled Trial
Minimal extracorporeal circulation reduces the incidence of postoperative major adverse events after elective coronary artery bypass grafting in high-risk patients. A single-institutional prospective randomized study.
Coronary artery bypass grafting (CABG) using minimal extracorporeal circulation (MECC) has been associated with an improved short-term clinical outcome compared to conventional extracorporeal circulation (CECC). The aim of this study was to evaluate the impact of MECC compared to CECC on postoperative major adverse events in high-risk patients undergoing elective coronary revascularization procedures. Two hundred patients undergoing elective CABG were randomized into two groups. ⋯ MECC was associated with a 77% relative risk reduction in the incidence of major adverse events compared to CECC (p=0.004). The rate of major adverse events occurring in the high-risk patient subgroup (preoperative left ventricular ejection fraction ≤40%, age >65 years, EuroSCORE II >5) operated on with MECC was significantly lower in comparison to their CECC counterparts. Based on our results, cardiac centres should be encouraged to use MECC as the standard circuit when performing elective coronary procedures, even in a high-risk population.
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Randomized Controlled Trial Multicenter Study Comparative Study
Cognitive deficit in first-time coronary artery bypass graft patients: a randomized clinical trial of lidocaine versus procaine hydrochloride.
Cognitive dysfunction increasingly has been recognized as a complication after cardiac surgery. Different methods have been considered for the reduction of cognitive dysfunction after cardiac surgery. One of these methods is by using lidocaine during surgery. The aim of this study was to determine the effects of adding lidocaine to the cardioplegia solution on cognitive impairment after coronary artery surgery. ⋯ Administration of lidocaine compared to that of procaine through the cardioplegia solution had a better effect on cognitive function after coronary artery bypass graft surgery.
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Randomized Controlled Trial Clinical Trial
Pump blood processing, salvage and re-transfusion improves hemoglobin levels after coronary artery bypass grafting, but affects coagulative and fibrinolytic systems.
Cell saving systems are commonly used during cardiac operations to improve hemoglobin levels and to reduce blood product requirements. We analyzed the effects of residual pump blood salvage through a cell saver on coagulation and fibrinolysis activation and on postoperative hemoglobin levels. Thirty-four elective coronary artery bypass graft (CABG) patients were randomized. ⋯ The cell salvage group of patients had increased chest tube drainage (749 ± 320 vs 592 ± 264; p: NS) and fresh frozen plasma transfusion rate (5 (29%) pts vs 0 pts; p<0.04). Pump blood salvage with a cell saving system improved postoperative hemoglobin levels, but induced a strong thrombin generation, fibrinolysis activation and lower fibrinolysis inhibition. These conditions could generate a consumption coagulopathy.