European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2010
Comparative StudyVancomycin plasma concentrations in cardiac surgery with the use of profound hypothermic circulatory arrest.
This study was undertaken to compare the effect of deep hypothermic circulatory arrest, compared with moderate hypothermia, on the plasma concentrations and pharmacokinetic profile of vancomycin, administered as prophylaxis, in patients undergoing cardiac surgery with cardiopulmonary bypass. ⋯ The dosing of vancomycin, if used as antibiotic prophylaxis, does not need to be adjusted in cardiac surgery patients when undergoing profound hypothermic circulatory arrest, since the plasma concentrations and pharmacokinetic profile are similar to patients with moderate hypothermia. The pharmacokinetic profile, consisting of three compartments, was not changed by the differences in temperature.
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Eur J Cardiothorac Surg · Dec 2010
Randomized Controlled Trial Comparative StudyCold blood versus cold crystalloid cardioplegia: a prospective randomised study of 345 aortic valve patients.
Although experimental studies have indicated that blood cardioplegia may be superior to crystalloid cardioplegia for myocardial protection, clinical data still remain uncertain. In a previous randomised study from our institution, including 1440 patients undergoing coronary artery bypass grafting (CABG), no beneficial effects of blood cardioplegia were seen in any relevant outcome variables. The investigation was therefore extended to a patient population having longer pump times and ischaemic periods. ⋯ There were no indications that retrograde cold blood cardioplegia was superior to retrograde cold crystalloid cardioplegia patients undergoing aortic valve replacement, with or without CABG.
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Eur J Cardiothorac Surg · Nov 2010
Aortic arch surgery using bilateral antegrade selective cerebral perfusion in combination with near-infrared spectroscopy.
Near-infrared spectroscopy (NIRS) complements online monitoring of cerebral oxygenation during aortic arch surgery. Its addition targets at an increase of safety of a complex procedure employing bilateral antegrade cerebral perfusion (BACP) and circulatory arrest under tepid blood temperatures. We report the outcome of NIRS-guided aortic arch surgery using BACP with moderate hypothermic circulatory arrest (MHCA). ⋯ NIRS-guided BACP during MHCA allows a safe approach to complex aortic arch surgery. The drop of brain oxygenation values in the contralateral hemisphere during unilateral ACP strongly suggests the routine use of BACP, when circulatory arrest under tepid temperatures is used.