European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 2009
Controlled Clinical TrialThe blood sparing effect and the safety of aprotinin compared to tranexamic acid in paediatric cardiac surgery.
Recently, the safety of aprotinin administration during open-heart surgery has been debated. The aim of the study was to compare the blood sparing effect and the side effects of aprotinin and tranexamic acid in paediatric cardiac surgery patients. ⋯ Aprotinin administration bears no additional risks compared to tranexamic acid and it has a stronger blood sparing effect in paediatric cardiac surgery. There were fewer rethoracotomies and less postoperative red blood cell transfusion in patients who received aprotinin.
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Eur J Cardiothorac Surg · Jan 2009
Multicenter StudySubaortic obstruction in univentricular heart: results using the double barrel Damus-Kaye Stansel operation.
We review our experience with relief of subaortic obstruction in univentricular hearts following pulmonary artery banding (PAB) with double barrel Damus-Kaye Stansel procedure (DKS) and subsequent staged palliation to Fontan. The purpose was to determine if PAB alters semilunar valve function after the double barrel DKS procedure and if this staged approach negatively influences the achievement of Fontan palliation. ⋯ PAB (+/-coarctation repair) with interval double barrel DKS is effective palliation for univentricular heart and excessive pulmonary blood flow. PAB does not create significant pulmonary insufficiency and subsequent DKS effectively relieves single ventricle to aortic gradient. Optimal second stage pulmonary blood flow is usually established with a bidirectional Glenn. The need for a Blalock shunt or a Glenn plus a Blalock is associated with increased mortality.
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Eur J Cardiothorac Surg · Jan 2009
Comparative StudyRelative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery.
Cardiac function may differ after valvular (VS) and coronary artery (CAS) surgery and this may affect assessment of fluid responsiveness. The aim of the study was to compare VS and CAS in the value of cardiac filling pressures and volumes herein. ⋯ While volumes are equally useful in monitoring fluid responsiveness, the predictive and monitoring value of PAOP is greater after VS than after CAS. In contrast, the CVP is of similar value as volume measurements in monitoring fluid responsiveness after CAS. The different value of pressures rather than of volumes between surgery types is likely caused by systolic left ventricular dysfunction in VS. The study suggests an effect of systolic cardiac function on optimal parameters of fluid responsiveness and superiority of the pulmonary artery catheter over transpulmonary dilution, for haemodynamic monitoring of VS patients.
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Eur J Cardiothorac Surg · Jan 2009
Comparative StudyFunctional and menometric study of side-to-side stapled anastomosis and traditional hand-sewn anastomosis in cervical esophagogastrostomy.
In the study, we made the pharyngoesophageal functional assessment and menometric study on the two kinds of anastomosis (traditional hand-sewn anastomosis and side-to-side stapled anastomosis) for the further evaluation and application of cervical esophagogastrostomy. ⋯ The side-to-side stapled technique is conducive to decrease complications of postoperative dysphagia and is helpful for improving pharyngesophageal and anastomotic menometric function. The anastomotic technique deserves more attention and further applications.
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Eur J Cardiothorac Surg · Jan 2009
Case ReportsMassive systemic air embolism during off-pump coronary artery surgery.
In OPCAB (off-pump coronary artery bypass) operations, development of cardiac arrest during the distal anastomosis to obtuse marginal coronary artery leads to significantly low blood pressure in the ascending aorta. Therefore, blowing of compressed air in high flow on not-slinged coronary artery may cause air mobilization from the coronary artery system into the ascending aorta that may result in severe brain damage.