Journal of cardiac surgery
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Hemostasis abnormalities in cardiovascular and aortic surgery remain a major source of morbidity and mortality in patients undergoing such complex procedures. The need for frequent transfusions of red cell and other blood products increases risks and costs to patients and institutions providing patient care. Specifically in cardiovascular and aortic surgery, the nature of the surgery is, at best, semi-elective, and careful preparation to preserve the hemostatic mechanisms of the body is essential. ⋯ Aorto intimal disease initiates fibrinolysis by the release of tissue plasminogen activator. Due to the numerous etiologies of bleeding, a combination of blood conservation strategies is suggested. The ideal combination of interventions has yet to be determined and is currently dependent on patient variables, physician and institutional practices, and economic pressures.
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Penetrating injuries to the thoracic great vessels have been diagnosed with increased frequency because of the escalating use of automatic weapons. The overall incidence is 5.3% of gunshot wounds and 2% of stab wounds to the chest. Most of these patients reach the hospital dead or in severe shock. ⋯ Angiography, color flow Doppler, and transesophageal echocardiography may be useful in selected cases. Patients in cardiac arrest or imminent cardiac arrest may benefit from an emergency room thoracotomy. The surgical approach to specific thoracic great vessels is described.
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In 1977, the use of Gelatine-Resorcine-Formaline (GRF) biological glue during surgery of acute Type A aortic dissection was proposed. The present study retrospectively analyzes the late results obtained with this adjunct in an experience extending over a twenty-year period of time. ⋯ The GRF glue has proved to be extremely useful during emergency initial surgery for acute type A dissection, making the procedure much easier and safer. Through this operative improvement, the use of the GRF glue seems to have a beneficial influence on the late results which however, depend mainly on the patient's basic condition.
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We currently routinely use profound hypothermic circulatory arrest (PHCA) with retrograde cerebral perfusion (RCP) during repair of proximal aortic dissection and aneurysms involving the transverse aortic arch. Experimental data regarding the efficacy of RCP are conflicting. We retrospectively reviewed our experience with proximal aortic surgery to compare the results of PHCA performed with and without RCP. ⋯ Patients who had RCP during PHCA had lower mortality and stroke rates than those who did not. Although the higher prevalence of cerebrovascular disease, diabetes, and dissection in the latter group may have contributed to these differences, the clinical results confirm the safety and potential benefits of RCP, further supporting its use during proximal aortic surgery requiring circulatory arrest.