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 1992
Complications from intra-aortic balloon counterpulsation: a review of 303 cardiac surgical patients.
From January 1980 to January 1990 all patients undergoing cardiac surgery at the Royal North Shore Hospital, Sydney, and requiring intra-aortic balloon counterpulsation (IABCP) were retrospectively reviewed. A total of 99 patients (32.6%) developed complications. Vascular/haemorrhagic complications occurred in 46 patients (15.2%); 79 patients (26%) required platelet transfusions. ⋯ Intra-aortic balloon pump-related deaths occurred in 6 patients (2%). Use of the intra-aortic balloon pump can be a life-saving procedure, but it carries a significant morbidity and mortality rate. This makes it imperative to temper our indications to those patients who demonstrate a need for it.
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Eur J Cardiothorac Surg · Jan 1992
Antiheart antibodies following open heart surgery: incidence and correlation with postpericardiotomy syndrome.
One-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis of myocardial proteins followed by Western blotting is a sensitive method for the detection of antiheart antibodies after cardiac transplantation. In a previous study we found that the majority of patients made antiheart antibodies after cardiac transplantation. It is possible that these antibodies were formed in response to cardiac damage caused during the surgical procedure rather than being specific to the transplantation situation. ⋯ Only 25% (9/36) of patients showed any increase in the pre-existing level of antiheart antibodies or developed antiheart antibodies with new reactivities. None of the patients in the study developed manifestations specific for post-pericardiotomy syndrome during the period of follow-up. The results support the contention that the high incidence of antiheart antibodies formed after cardiac transplantation is due to a humoral immune response to the presence of alloantigens on the grafted heart rather than as a result of the surgical procedure itself.
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Eur J Cardiothorac Surg · Jan 1992
The effects of preoperative aspirin therapy on platelet function in cardiac surgery.
Extracorporeal circulation is known to have profound effects upon platelets. Changes in platelet function were assessed in 20 patients undergoing elective coronary artery bypass grafting (CABG) who stopped taking aspirin (100 mg per day) 5-7 days before the operation compared with 20 patients undergoing aortic valve replacement (AVR) who had never taken anticoagulants or aspirin. Platelet aggregometry was carried out using the turbidimetric technique (inducing agents: adenosine diphosphate (ADP) 1.0 and 2.0 mumol/l; collagen 4 micrograms/ml; epinephrine 25 mumol/l), and maximum aggregation as well as the maximum gradient of aggregation were monitored before, during, and after cardiopulmonary bypass (CPB) until the 1st postoperative (p.o.) day. ⋯ The aggregation variables of the CABG patients were lower than in the AVR patients as early as after the induction of anesthesia (difference in maximum aggregation ranged from 13-29%). During CPB and immediately thereafter, all aggregation variables were significantly reduced in the CABG patients (reduction in maximum aggregation ranged from -32 to -49%) and were significantly different from the platelet aggregation in the AVR patients. Five hours after CPB and on the 1st p.o. day platelet aggregation in the CABG group almost returned to baseline values, however, without reaching the values of the AVR patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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To determine the role of expandable metal stent (Wallstent) in treating tracheobronchial strictures, 12 patients with recurrent symptoms of airway obstruction due to either benign or malignant strictures were studied. The seven benign strictures were anastomotic stricture following sleeve resection (2) and single lung transplant (1), tracheal amyloidosis (1), idiopathic chondritis (2), and post-tracheostomy stricture (1). The five malignant strictures were due to recurrent adenoid cystic carcinoma of trachea (1), large-cell carcinoma of lung (1), recurrent laryngeal squamous carcinoma (1), squamous carcinoma of the trachea (1), and malignant melanoma (1). ⋯ One patient with relief of stridor died at 4 months due to carcinomatosis. Tumour ingrowth through the metal stent remains problematic in two patients. However, the incidence of palliative interventions required has markedly reduced after stenting.
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Eur J Cardiothorac Surg · Jan 1991
Case ReportsExtracorporeal membrane oxygenation as a bridge to lung transplantation.
The occurrence of severe graft failure after lung transplantation which appears refractory to conventional treatment represents a difficult situation with regard to the therapeutic strategies available. Of 17 patients undergoing single lung transplantation at our center, 2 developed early graft failure. In both, temporary artificial cardiopulmonary support by means of extracorporeal membrane oxygenation became necessary as a bridge to retransplantation. ⋯ Cachexia and several episodes of viral pneumonia contributed to the progressive deterioration of her clinical status. She finally died after being hospitalized for 5 months after the original operation. These two cases illustrate the feasibility of using extracorporeal membrane oxygenation as a bridge to pulmonary transplantation.