Journal of cardiac surgery
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The mortality and morbidity associated with surgery for aortic root abscess is reportedly high. This is a review of our experience with radical resection of the abscess and reconstruction of the left ventricular outflow tract with pericardium. ⋯ Radical resection of aortic root abscess and reconstruction of the left ventricular outflow tract with pericardium is an effective method to eradicate the infection. These patients appear to have a relatively high risk of recurrent endocarditis.
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Hemostasis is a significant problem in aortic surgery requiring profoundly hypothermic techniques. Aprotinin, a serine protease inhibitor, reduces blood loss in high-risk coronary and valve surgery, but its use in profound hypothermia is controversial. ⋯ This data does not support the adverse effect of aprotinin upon early survival. Although early reports were of concern, the role of aprotinin as an adjunct to hemostasis requires further investigation.
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Randomized Controlled Trial Clinical Trial
Randomized, placebo-controlled, double-blind study of an ultra-low-dose aprotinin regimen in reoperative and/or complex cardiac operations.
High-dose aprotinin is an effective but costly method to reduce transfusions after cardiopulmonary bypass (CPB). Very low doses of aprotinin have been shown to be effective in primary cardiac surgery, but not in patients undergoing procedures associated with the greatest usage of allogeneic blood products after CPB. We evaluated the efficacy of ultra-low-dose aprotinin in this patient population. ⋯ Prophylactic administration of ultra-low-dose aprotinin reduced transfusions in patients undergoing repeat operations or complex procedures. Aprotinin could be used in a more economical manner, even in this patient population at high-risk of receiving allogeneic blood products.
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Mobile right atrial thrombus is an uncommon finding on two-dimensional (2D) echocardiography. Therapeutic alternatives include systemic heparinization, systemic or local thrombolysis, and surgical removal. We report our clinical experience in six patients over a 3-year period (6000 echocardiograms) at a tertiary care referral center. ⋯ Mobile thrombus in the right atrium is an unusual echocardiographic finding. It portends a poor prognosis with death due to pulmonary embolism.
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Comparative Study
Enhanced blood conservation and improved clinical outcome after valve surgery using heparin-bonded cardiopulmonary bypass circuits.
Recently, heparin-bonded (HBC) cardiopulmonary bypass circuits (CPB) were formed to be associated with improved outcome after coronary artery bypass grafting. There are very few reports on the efficacy and safety of these circuits in valve surgery. ⋯ Use of HBCs with lower anticoagulation in valve surgery resulted in a significant reduction of transfusion requirements and improved clinical outcome. Because of a potential for early mechanical valve thrombosis, until further data is available, conventional levels of systemic anticoagulation should be achieved when using HBC in valve surgery.