European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2004
Comparative StudyTemperature monitoring during cardiopulmonary bypass--do we undercool or overheat the brain?
Brain cooling is an essential component of aortic surgery requiring circulatory arrest and inadequate cooling may lead to brain injury. Similarly, brain hyperthermia during the rewarming phase of cardiopulmonary bypass may also lead to neurological injury. Conventional temperature monitoring sites may not reflect the core brain temperature (Tdegrees). We compared jugular bulb venous temperatures (JB) during deep hypothermic circulatory arrest and normothermic bypass with Nasopharyngeal (NP), Arterial inflow (AI), Oesophageal (O), Venous return (VR), Bladder (B) and Orbital skin (OS) temperatures. ⋯ If brain venous outflow Tdegrees (JB) accurately reflects brain Tdegrees, NP Tdegrees is a safe surrogate indicator of cooling. During rewarming, all peripheral sites underestimate brain temperature and caution is required to avoid hyperthermic arterial inflow, which may inadvertently, result in brain hyperthermia.
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Eur J Cardiothorac Surg · Sep 2004
Comparative StudyOperative mortality after conventional versus coronary revascularization without cardiopulmonary bypass.
Off-pump coronary artery bypass (CABG) is a safe revascularization option with comparable or superior results to the conventional on-pump CABG. However, comparative analysis of the type of surgical approach on the mortality rate is largely unknown. This study sought to investigate whether CABG without cardiopulmonary bypass (off-pump CABG) is associated with lower operative mortality than the conventional on-cardiopulmonary bypass (on-pump) approach. ⋯ Excellent clinical results and a lower operative mortality rate can be achieved with the off-pump CABG technique compared with the conventional on-pump approach.
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Eur J Cardiothorac Surg · Sep 2004
Cardiac output monitoring by pressure recording analytical method in cardiac surgery.
A less-invasive method has been developed that may provide an alternative to monitor cardiac output from arterial pressure: beat-to-beat values of cardiac output can be obtained by pressure recording analytical method (PRAM). The purpose of this study was to assess the reliability of cardiac output determination by PRAM in cardiac surgery. ⋯ Under the studied conditions, our results demonstrate good agreement between PRAM data and ThD measurements, and this new method has shown to be accurate for real-time monitoring of cardiac output in cardiac surgery. Further studies will be required to assess this method in higher-risk patients and in the setting of haemodynamic instability or arrhythmias. This is the first study designed to assess the accuracy of PRAM in cardiac surgery.
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Eur J Cardiothorac Surg · Sep 2004
Influence of obesity on in-hospital and early mortality and morbidity after myocardial revascularization.
Obese patients are thought to have an increased risk for complications in coronary artery bypass surgery. Several risk stratification systems do not identify obesity as a variable for risk adjustment. The aim of this study is to evaluate the in-hospital and early (one year) mortality and morbidity in obese and non-obese patients after a CABG in the UMC St Radboud. ⋯ Obese patients do not have an increased risk of in-hospital and early (1 year) mortality after CABG. However, obese patients have an increased risk of postoperative wound infections compared to non-obese patients.
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Eur J Cardiothorac Surg · Sep 2004
Comparative StudyVentilation prevents pulmonary endothelial dysfunction and improves oxygenation after cardiopulmonary bypass without aortic cross-clamping.
Endothelial dysfunction of the pulmonary arterial tree occurring after cardiopulmonary bypass (CPB) contributes to pulmonary hypertension and respiratory failure in the postoperative period. The goal of the present study was to characterize the alterations of endothelial cell signal transduction pathways in pulmonary arteries following CPB, the effect of ventilation and nitric oxide (NO) inhalation on endothelium-dependent relaxations and the alterations in hemodynamics and oxygenation. ⋯ Pulmonary reperfusion after CPB causes a selective dysfunction of Gi-protein-mediated relaxations. Mechanical ventilation prevents the pulmonary endothelial dysfunction due to reperfusion after CPB. Ventilation also improves oxygenation after CPB. Mechanical ventilation could be used as a preventive approach for patients undergoing cardiac surgery with extracorporeal circulation.