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 1995
Case ReportsLeg ischaemia following bilateral internal thoracic artery and inferior epigastric artery harvesting.
There is increasing evidence that the use of arterial conduits for coronary artery bypass grafting provides superior long-term results when compared to using saphenous veins alone. Major complications of using internal thoracic arteries (ITAs) and inferior epigastric arteries (IEAs) are uncommon. ⋯ The enormous size of these conduits found at operation suggested their role. Management strategies to avoid such a serious complication are discussed.
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Eur J Cardiothorac Surg · Jan 1995
Comparative Study Clinical TrialConsistent non-pharmacologic blood conservation in primary and reoperative coronary artery bypass grafting.
Because much interest has been focused on blood conservation using different drugs and complicated blood cell processing devices, we analyzed our results with the use of a non-pharmacologic, simple and inexpensive program for blood salvage in 2326 patients undergoing myocardial revascularization. The material was divided into two groups: patients undergoing a primary coronary bypass operation (Group P, n = 2298) and a smaller subset of patients undergoing repeat coronary bypass operation (Group R, n = 28). At least one internal mammary artery was grafted in 99% of the patients, with supplemental saphenous vein grafts. ⋯ In Group R, 1 patient (3.6%) received packed red cells and no patients were given other homologous blood products, compared to 33 patients (1.4%) given red cells and 35 patients (1.5%) given plasma transfusion in Group P (NS). Thus, in total, 2257 patients (97.0%) were not exposed to any homologous blood products during hospitalization. Total hemoglobin loss was significantly higher in Group R, resulting in a mean hemoglobin concentration at discharge of 109 +/- 13 g/l, compared to 121 +/- 14 g/l in Group P (P = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)
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Although cardiomyoplasty has become a recognized treatment for end-stage heart failure, the effects of this procedure on systolic and diastolic function are still unclear. To determine the effects of paced and non-paced latissimus dorsi cardiomyoplasty on systolic and diastolic function, the maximal elastance of the left ventricle (Emax), stroke volume, preload recruitable stroke work and diastolic compliance were measured in an experimental heart failure model. Collateral blood vessels to the latissimus dorsi were ligated 2 weeks before cardiomyoplasty in order to reduce the risk of ischemic injury. Histological examination of muscle biopsies confirmed that the two-stage procedure preserved normal muscle architecture. The non-paced cardiomyoplasty wrap adversely affected both systolic and diastolic function. Paced Latissimus Dorsi during heart failure improved systolic function but had no measurable effect on diastolic function. ⋯ 1. Non-paced, or unstimulated, latissimus dorsi cardiomyoplasty acutely impairs cardiac function. 2. Delayed cardiomyoplasty, 2 weeks after collateral ligation, prevents ischemic injury to the muscle flap.
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While lung retransplantation remains the only therapeutic option in early or late graft failure, its value is viewed controversially. Of 134 patients undergoing pulmonary transplantation in our institution, 13 patients underwent 14 redos following heart-lung transplantation (n = 3), bilateral lung transplantation (n = 5), and unilateral lung transplantation (n = 5). Indications for retransplantation were acute graft failure (n = 2), persistent graft dysfunction (n = 3), airway complications (n = 2), and chronic graft failure (n = 7). ⋯ This was slightly lower than in the overall population following primary isolated lung transplantation (83 and 80%). Actuarial freedom from obliterative bronchiolitis (stage 3) at 1 and 2 years was calculated at 88 and 27% (primary grafts: 88% vs 72%; P < 0.05). Retransplantation is a realistic option in early and late graft failure after lung transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Randomized Controlled Trial Clinical TrialSuppressed fibrinolysis after administration of low-dose aprotinin: reduced level of plasmin-alpha2-plasmin inhibitor complexes and postoperative blood loss.
Various clinical investigation have shown that aprotinin therapy reduces bleeding after open-heart operations. In this study low-dose aprotinin, 30,000 KIU/kg in the cardiopulmonary bypass (CPB) priming volume and 7,500 KIU/kg intravenously each hour during CPB, was used in ten patients undergoing primary myocardial revascularization or surgery for valvular diseases. Another ten patients served as controls. ⋯ The levels of plasmin inhibitor were significantly reduced during CPB in the control group. The alpha 2-plasmin inhibitor-plasma complex levels, indicating the plasmin activity, were significantly reduced in the aprotinin group. These results confirmed that low-dose aprotinin reduced blood loss with the prevention of hyperfibrinolysis during CPB and demonstrated improved hemostasis.