European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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A 90 degree bent two-stage venous cannula for cardiopulmonary bypass is presented and discussed. Its main advantages, compared to similar straight ones, are that it is out of the way of the surgeon, by being placed under the right sternum and also that the venous return seems uninfluenced by displacement of the heart when operating on the posterior side of the heart. No major drawbacks for the cannula have been noticed so far.
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudySurgery for acute ascending aortic dissection: closed versus open distal aortic repair.
One hundred twelve consecutive patients with acute ascending aortic dissection and submitted to immediate surgery were retrospectively analyzed with regard to perioperative mortality and morbidity. The patients were divided into two groups according to whether distal aortic repair was carried out by the open procedure (using deep hypothermic circulatory arrest, group A: 68 patients) or by the closed technique (without circulatory arrest, group B: 44 patients). Patients' ages ranged from 24 to 78 years (mean 57.4 years). ⋯ The trend towards a higher mortality in group A mainly reflected the more severe and complex anatomical characteristics and could not be attributed to the circulatory arrest per se. The period of deep hypothermic circulatory arrest in the survivors (25 min) was similar to that of the group with lethal outcome (32 min). Among the non-lethal complications, however, group A patients more frequently showed clinical signs consistent with cerebral injury: apart from the transient symptoms suggestive in reversible diffuse cerebral damage, five patients in group A had a permanent focal neurological deficit (versus one patient in group B).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudyInterrupted warm blood cardioplegia for coronary artery bypass grafting.
Continuous warm blood cardioplegia has been used with good clinical outcome in both antegrade and retrograde delivery. However, the continuous delivery of cardioplegia is sometimes interrupted for adequate visualization and flow is not constant with heart manipulation during operation. We studied the effects of interrupted antegrade delivery of warm blood cardioplegia on myocardial metabolism and clinical results after surgery. ⋯ After removal of the aortic cross-clamp, the heart returned to sinus rhythm spontaneously in 90% of the patients with warm cardioplegia and 15.4% of those with a cold heart (P < 0.01). Postoperatively, there was no significant CK-MB or MDA release in either group except for one patient with perioperative myocardial infarction. After operation inotropic support was required for two and one patient in the warm and cold groups, respectively, although there were significantly more patients with poor left ventricular function in the warm, than in the cold, group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsMechanical ventricular assistance for the failing right ventricle after cardiac transplantation.
Right ventricular failure secondary to elevated pulmonary vascular resistance (PVR) following orthotopic cardiac transplant is a complication with a high mortality; and patients with high resistance are often not accepted on transplant waiting lists. We describe six cases of right ventricular failure after cardiac transplant managed by right ventricular assist device (RVAD), four of whom died and two patients who survived following life-threatening complications.
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsEsophageal tracheobronchoplasty for membranous laceration caused by insertion of a dumon stent--maintenance of oxygenation by percutaneous cardiopulmonary support.
A 39-year-old man, whose airway was narrowed due to relapsing polychondritis, sustained a tracheobronchial injury during intubation with an internal stent. In the posterior membranous trachea and left main stem bronchus, a 5-cm longitudinal tear extended across the carina. ⋯ An original esophageal tracheobronchoplasty for repair of the membranous laceration is described. Currently, the patient is asymptomatic 16 months after the surgery.