The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2003
Sternal puncture allows an early diagnosis of poststernotomy mediastinitis.
Poststernotomy mediastinitis after cardiac operations is a nosocomial infection involving the mediastinal space and the sternum, with a high mortality rate mostly related to a late diagnosis. We investigated whether sternal puncture might facilitate and shorten the delay in the diagnosis of mediastinitis. ⋯ Our study shows that sternal puncture is a rapid and safe method to ensure the diagnosis of poststernotomy mediastinitis.
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J. Thorac. Cardiovasc. Surg. · Mar 2003
Randomized Controlled Trial Clinical TrialLong-term amiodarone therapy and the risk of complications after cardiac surgery: results from the Canadian Amiodarone Myocardial Infarction Arrhythmia Trial (CAMIAT).
This study was undertaken to determine the association between amiodarone therapy and risk of complications of cardiac surgery in patients in the randomized placebo-controlled, double-blind Canadian Amiodarone Myocardial Infarction Arrhythmia Trial. ⋯ Patients receiving long-term amiodarone treatment after myocardial infarction had a higher rate of intra-aortic balloon use after cardiac surgery. There was no increased risk of pulmonary complications, need for pacing, or death.
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J. Thorac. Cardiovasc. Surg. · Mar 2003
Randomized Controlled Trial Clinical TrialInhaled epoprostenol (prostacyclin) and pulmonary hypertension before cardiac surgery.
Pulmonary hypertension is commonly found in patients undergoing valvular surgery and can be worsened by cardiopulmonary bypass. Inhaled epoprostenol (prostacyclin) has been used for the treatment of pulmonary hypertension, but its effects compared with those of placebo on hemodynamics, oxygenation, echocardiographic examination, and platelet function have not been studied during cardiac surgery. ⋯ Inhaled epoprostenol reduces pulmonary pressure and improves right ventricular stroke work in patients with pulmonary hypertension undergoing cardiac surgery. A dose of 60 microg is hemodynamically safe, and its effect is completely reversed after 25 minutes. We did not observe any evidence of platelet dysfunction or an increase in surgical bleeding after administration of inhaled epoprostenol.
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J. Thorac. Cardiovasc. Surg. · Mar 2003
Fructose-1,6-bisphosphate for improved outcome after hypothermic circulatory arrest in pigs.
Fructose-1,6-bisphosphate is a high-energy intermediate in the anaerobic metabolism. It enhances glycolysis, preserves cellular adenosine triphosphate, and prevents the increase of intracellular calcium during ischemia. The potential neuroprotective effect of fructose-1,6-bisphosphate during hypothermic circulatory arrest was evaluated in a surviving porcine model. ⋯ Intravenous administration of fructose-1,6-bisphosphate at 500 mg/kg before and after hypothermic circulatory arrest in a surviving porcine model was associated with better survival, behavioral outcome, and histopathologic score. The observed lower blood creatine kinase isoenzyme MB and brain glycerol levels and the higher brain glucose, pyruvate, and lactate levels in the fructose-1,6-bisphosphate group suggest that this drug has supportive effects on myocardial and brain metabolisms.
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J. Thorac. Cardiovasc. Surg. · Mar 2003
Novel cerebral physiologic monitoring to guide low-flow cerebral perfusion during neonatal aortic arch reconstruction.
This study was undertaken to describe the combined measurement of cerebral blood flow velocity and cerebral oxygen saturation as a guide to bypass flow rate for regional low-flow perfusion during neonatal aortic arch reconstruction. ⋯ Cerebral blood flow velocity, as determined by transcranial Doppler ultrasonography, adds valuable information to cerebral oxygen saturation data in guiding bypass flow during regional low-flow perfusion. Its most important use may be prevention of cerebral hyperperfusion during periods with high near-infrared spectroscopic saturation values.