The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 1992
Different effects of activated platelets in the right gastroepiploic and internal mammary arteries. Implications for coronary artery grafting.
The right gastroepiploic artery is increasingly utilized as an alternative coronary bypass conduit, although postoperative spasm can represent a problem. Platelet-vessel wall interactions are important determinants of graft function and patency. We studied the effects of activated platelets in porcine and human gastroepiploic and mammary arteries. ⋯ Although endothelium-dependent and endothelium-independent relaxation to bradykinin and the nitrovasodilator 3-morpholino sydnonimine were more pronounced in the gastroepiploic than in the mammary artery, norepinephrine, serotonin, and potassium chloride evoked much stronger contractions in the former than in the latter. Thus activated platelets induce pronounced contraction of the gastroepiploic artery that may contribute to postoperative spasm. The administration of antiplatelet drugs and vasodilators that prevent the effects of thromboxane A2 and serotonin may be beneficial for gastroepiploic graft function.
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J. Thorac. Cardiovasc. Surg. · Nov 1992
Subglottic tracheal resection and synchronous laryngeal reconstruction.
Postintubation injury of the upper airway commonly results in stenotic lesions of the larynx, subglottis, and adjacent trachea. The traditional approach to surgical correction is laryngofissure for the laryngeal component and staged plastic reconstruction of the subglottic stenosis. Reported results are variable and unpredictable, and permanent extubation is impossible in a significant number of patients. ⋯ Vocal function is satisfactory to good in these patients. The approach described for these combined laryngotracheal lesions provides better results than those reported with traditional staged and plastic techniques of reconstruction. The collaboration of the departments of otolaryngology and thoracic surgery was essential to achieve these results.
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J. Thorac. Cardiovasc. Surg. · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparative study of cefazolin, cefamandole, and vancomycin for surgical prophylaxis in cardiac and vascular operations. A double-blind randomized trial.
Three-hundred twenty-one adults undergoing cardiac or major vascular operations were randomized to receive intravenous cefazolin, cefamandole, or vancomycin for prophylaxis against surgical infection in a double-blind trial. All three regimens provided therapeutic blood levels throughout operation in patients studied undergoing cardiopulmonary bypass. The prevalence of surgical wound infection was lowest with vancomycin (4 infections [3.7%] versus 14 [12.3%] and 13 [11.5%] in the cefazolin and cefamandole groups, respectively; p = 0.05); there were no thoracic wound infections in cardiac operations in the vancomycin group (p = 0.04). ⋯ We conclude that administration of vancomycin (approximately 15 mg/kg), immediately preoperatively, provides therapeutic blood levels for surgical prophylaxis throughout most cardiac and vascular operations, resulting in protection against postoperative infection superior to that obtained with cefazolin or cefamandole. Vancomycin deserves consideration for inclusion in the prophylactic regimen (1) for prosthetic valve replacement and prosthetic vascular graft implantation, to reduce the risk of implant infection by methicillin-resistant coagulase-negative staphylococci and enterococci; (2) for any cardiovascular operation if the patient has recently received broad-spectrum antimicrobial therapy; and (3) for all cardiovascular operations in centers with a high prevalence of surgical infection with methicillin-resistant staphylococci or enterococci. Guidelines for dosing and administration of vancomycin for cardiovascular surgical prophylaxis are provided.
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J. Thorac. Cardiovasc. Surg. · Nov 1992
Transesophageal echocardiography predicts successful withdrawal of ventricular assist devices.
Transesophageal echocardiography has been found to be an effective technique for the real-time assessment of myocardial and valvular function in postoperative patients. To determine the value of transesophageal echocardiography in patients with mechanical assist devices, we performed daily, bedside transesophageal echocardiography on 16 patients with right (n = 3), left (n = 1), or biventricular assist devices (n = 12). We obtained four-chamber and short-axis views in all patients. ⋯ Marked hemodynamic improvement occurred after surgical decompression. In conclusion, transesophageal echocardiography is a safe, effective method for the assessment of ventricular function of patients on ventricular assist device support. In addition, it allows one to assess valvular function and the presence or absence of impaired ventricular filling.