Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Feb 2008
Randomized Controlled TrialAprotinin reduces cardiac troponin I release and inhibits apoptosis of polymorphonuclear cells during off-pump coronary artery bypass surgery.
In addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting. ⋯ The authors conclude that aprotinin reduces perioperative cardiac troponin I release and attenuates apoptosis in polymorphonuclear cells but has no significant effects on plasma cytokine levels in patients undergoing off-pump coronary artery bypass graft surgery.
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J. Cardiothorac. Vasc. Anesth. · Feb 2008
Comparative StudyEvaluation of a new platelet function analyzer in cardiac surgery: a comparison of modified thromboelastography and whole-blood aggregometry.
Impaired hemostasis of multiple etiologies are often present in patients undergoing cardiopulmonary bypass (CPB) surgery. Platelet dysfunction is considered to be important in the early postoperative period. Therefore, a new whole-blood platelet function analyzer was compared with thromboelastography in predicting postoperative hemostatic outcomes as measured by blood loss and blood product use. ⋯ Impedance aggregometry as well as thromboelastography are able to detect impaired hemostasis after CPB. In contrast to thromboelastography, aggregometry using a new whole-blood aggregometer identified patients with a reduced risk for postoperative transfusion requirements.
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J. Cardiothorac. Vasc. Anesth. · Feb 2008
Comparative StudyPerioperative renal outcome in cardiac surgical patients with preoperative renal dysfunction: aprotinin versus epsilon aminocaproic acid.
The administration of aprotinin to patients with pre-existing renal dysfunction who are undergoing cardiac surgery is controversial. Therefore, the authors present their experience with the use of aprotinin for patients with preoperative renal dysfunction who underwent elective cardiac surgery requiring cardiopulmonary bypass (CPB). ⋯ Acute perioperative renal dysfunction was associated with worse patient outcome and longer CPB and AoXCl times. Demographic and surgical variables indicated that the sicker patients undergoing more complex surgeries were more likely to be treated with aprotinin. Although aprotinin patients had a higher renal risk score, the administration of aprotinin did not negatively impact renal outcome.
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J. Cardiothorac. Vasc. Anesth. · Feb 2008
Comparative StudyComparison of central venous to mixed venous oxygen saturation in patients with low cardiac index and filling pressures after coronary artery surgery.
To evaluate the correlation and agreement between mixed venous oxygen saturation (SvO(2)) and central venous oxygen saturation (ScvO(2)) in patients with low cardiac index and filling pressures after coronary artery surgery. ⋯ In patients with low cardiac index and filling pressures after coronary artery surgery, ScvO(2) could not be used as a direct alternative for SvO(2). After fluid therapy and normalization of the cardiac index, differences between individual values remained large, and the disagreement between ScvO(2) and SvO(2) changes was significant.
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J. Cardiothorac. Vasc. Anesth. · Feb 2008
Comparative StudyClopidogrel treatment before coronary artery bypass graft surgery increases postoperative morbidity and blood product requirements.
An increasing number of patients are referred for coronary artery bypass graft surgery while treated with clopidogrel. This agent inhibits the platelet P2Y12 adenosine-5'-diphosphate (ADP) receptor, which results in an inhibition of platelet aggregation. The aim of this study was to determine the effect of preoperative clopidogrel treatment on postoperative bleeding, mortality, and morbidity in patients after coronary artery bypass graft surgery. ⋯ Preoperative clopidogrel is associated with increased transfusion requirement after coronary artery bypass graft surgery. The present data suggest that all-cause mortality and major morbidity may also increase in these patients. In clopidogrel-treated patients, coronary artery bypass graft surgery should be delayed in the absence of specific medical indications as recommended by recent American Heart Association guidelines.