The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2002
How common is severe pulmonary hypertension after pediatric cardiac surgery?
Pulmonary hypertension may result in significant morbidity and mortality after pediatric cardiac surgery. The objective of this study was to determine the incidence and outcome of severe pulmonary hypertension, defined as a ratio of pulmonary to systemic arterial pressure equal to or greater than 1.0, after cardiac surgery in children. ⋯ Severe postoperative pulmonary hypertension occurred after 2% of the cardiac procedures and in most cases was managed successfully with conventional treatment and had a favorable postoperative outcome. The low incidence relative to previous reports may reflect the benefits of early correction and improved intraoperative and postoperative care.
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J. Thorac. Cardiovasc. Surg. · May 2002
Randomized Controlled Trial Comparative Study Clinical TrialFailure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest.
Although retrograde cerebral perfusion has become a popular adjunctive technique and may improve cerebral ischemic tolerance during hypothermic circulatory arrest, direct cerebral metabolic benefit has yet to be demonstrated in human subjects. We investigated the post-arrest metabolic phenomena with and without retrograde cerebral perfusion in patients. ⋯ Retrograde cerebral perfusion did not influence immediate post-arrest nasopharyngeal temperature or cerebral metabolic recovery. The low jugular bulb Po(2) suggests equivalent ischemia. These findings cast doubt on the effectiveness of retrograde cerebral perfusion as a metabolic adjunct to hypothermic circulatory arrest.
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J. Thorac. Cardiovasc. Surg. · May 2002
Comparative StudyGain and subsequent loss of lung function after lung volume reduction surgery in cases of severe emphysema with different morphologic patterns.
Surgical lung volume reduction improves lung function and dyspnea in advanced emphysema to a variable degree. Because long-term results with this procedure are scant, we prospectively investigated lung function over several years after lung volume reduction surgery with regard to emphysema morphology. ⋯ Lung volume reduction surgery improves lung function in severe homogeneous and, to an even greater extent, heterogeneous emphysema. Forced expiratory volume in 1 second peaks within 6 months postoperatively. The subsequent decline is most rapid in the first year and slows down in succeeding years according to an exponential decay. Therefore, long-term functional results of lung volume reduction surgery may be more favorable than expected from linear extrapolations of short-term observations.
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J. Thorac. Cardiovasc. Surg. · May 2002
Vacuum-assisted closure therapy guided by C-reactive protein level in patients with deep sternal wound infection.
Deep sternal wound infection is a serious and potentially lethal complication of cardiac surgery when performed through a median sternotomy. We describe the outcome of a new treatment strategy with C-reactive protein level-guided vacuum-assisted closure used at our department. ⋯ Early vacuum-assisted closure treatment, followed by surgical closure guided by the plasma C-reactive protein level, is a reliable and easily applied new strategy in patients with postoperative deep sternal wound infection.
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J. Thorac. Cardiovasc. Surg. · May 2002
Randomized Controlled Trial Comparative Study Clinical TrialThe insulin cardioplegia trial: myocardial protection for urgent coronary artery bypass grafting.
Small, nonrandomized clinical trials have demonstrated a beneficial effect of solutions containing insulin and glucose on the recovery of myocardial metabolism and ventricular function after cardioplegic arrest and reperfusion. However, no large, blinded, randomized study has yet determined the effects of insulin-enhanced cardioplegia on clinical outcomes after coronary artery bypass grafting. ⋯ Despite encouraging results from smaller, nonrandomized studies, the Insulin Cardioplegia Trial failed to demonstrate a clinical benefit of insulin-enhanced cardioplegic solution for patients undergoing high-risk isolated coronary artery bypass grafting.