The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialFibrillation in patients subjected to coronary artery bypass grafting.
Atrial fibrillation is the most frequently encountered postoperative arrhythmic complication after coronary artery bypass grafting. Ischemic preconditioning has proved a potent endogenous factor in suppressing ischemia-reperfusion-induced arrhythmias. The protective effect of ischemic preconditioning on atrial fibrillation after coronary artery bypass grafting has not been studied. The purpose of the present study was to investigate whether ischemic preconditioning had an effect on postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. ⋯ Postcoronary artery bypass grafting atrial fibrillation is associated with more complicated postoperative outcome. Higher preoperative heart rate and postoperative pulmonary capillary wedge pressure were the independent predictors of atrial fibrillation. Recent unstable angina is not related to the occurrence of postcoronary artery bypass grafting atrial fibrillation. Ischemic preconditioning significantly suppresses postcoronary artery bypass grafting atrial fibrillation, suggesting that ischemic preconditioning can be used as an effective prophylactic method for postoperative atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyRight ventricular to pulmonary artery conduit instead of modified Blalock-Taussig shunt improves postoperative hemodynamics in newborns after the Norwood operation.
Perioperative mortality, prolonged postoperative recovery after the Norwood procedure, and mortality between stage I and stage II might be related to shunt physiology. A right ventricular to pulmonary artery conduit offers a banded physiology in contrast to a Blalock-Taussig shunt. The purpose of this study was to assess the hemodynamic differences and their consequences in the postoperative course between Norwood patients with a Blalock-Taussig shunt and those with a right ventricular to pulmonary artery conduit. ⋯ A higher diastolic blood pressure and a lower Qp/Qs ratio were associated with a more stable and efficient circulation in patients with a right ventricular to pulmonary artery conduit. More intensive ventilatory support was necessary during the first postoperative days. We did not note any adverse effects of the ventriculotomy on ventricular performance.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyDecreasing significance of left ventricular dysfunction and reoperative surgery in predicting coronary artery bypass grafting-associated mortality: a twelve-year study.
Patients undergoing coronary artery bypass grafting are older and have greater comorbidity than those operated on previously. We evaluated the changes in the predictors of in-hospital mortality among patients undergoing coronary artery bypass grafting during the last 12 years. ⋯ Despite increasing patient age and comorbidity, improvements in perioperative management have reduced the significance of severe left ventricular dysfunction and reoperative coronary artery bypass grafting but not emergency surgery as predictors of in-hospital mortality.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Comparative Study Clinical TrialImproved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial.
We sought to determine whether a continuous regional infusion of a local anesthetic delivered to the operative site would result in decreased levels of postoperative pain and narcotic requirements for patients who undergo a standard median sternotomy for cardiac surgery. ⋯ Continuous delivery of local anesthetics significantly improved postoperative pain control while decreasing the amount of narcotic analgesia required in patients who underwent standard median sternotomy. There was also a significant decrease in hospital length of stay, which is likely to result in significant cost reductions.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Randomized Controlled Trial Clinical TrialThe dynamic air bubble trap reduces cerebral microembolism during cardiopulmonary bypass.
Neuropsychologic disorders are common after coronary artery bypass operations. Air microbubbles are identified as a contributing factor. A dynamic bubble trap might reduce the number of gaseous microemboli. ⋯ Gaseous microemboli can be removed with a dynamic bubble trap. Subclinical cerebral injury detectable by increases of S100 beta disappears earlier after surgical intervention.