The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Case ReportsCatastrophic consequences of internal mammary artery hypoperfusion.
Inappropriate use of the internal mammary artery for complex coronary artery bypass operations may have disastrous yet avoidable consequences. In 712 consecutive coronary artery bypass operations performed between January 1985 and September 1986, five patients had an intraoperative course suggesting internal mammary artery hypoperfusion. In three, coronary artery bypass was performed as a reoperative procedure. ⋯ Internal mammary artery hypoperfusion typically occurred 30 to 40 minutes after discontinuation of cardiopulmonary bypass but was also seen in the intensive care unit. The condition may be confused with internal mammary artery or coronary artery spasm. It may be avoided by careful prebypass planning of the operation, intraoperative assessment of internal mammary artery flow and size with prudent use of sequential internal mammary artery grafting, avoiding use of the terminal left anterior descending (unless large), retaining nonobstructed saphenous vein grafts when the internal mammary artery has marginal flow or size, and placement of a saphenous vein graft distal to the left internal mammary artery when size or flow in the latter is small.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialTriiodothyronine as an inotropic agent after open heart surgery.
Two small, randomized, blind clinical trials comparing the administration of triiodothyronine with that of placebo have been carried out in patients undergoing myocardial revascularization. In patients with a left ventricular ejection fraction of less than 30% (study I), triiodothyronine administration at the end of operation and during the initial 24 hours after operation was associated with a significantly reduced need for conventional inotropic agents (p less than 0.02) and diuretics (p less than 0.02). ⋯ There were no adverse reactions to triiodothyronine in the dosages that were used. Triiodothyronine appears to be beneficial to all patients undergoing open heart surgery.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Surgical treatment of aneurysm and/or dissection of the ascending aorta, transverse aortic arch, and ascending aorta and transverse aortic arch. Factors influencing survival in 717 patients.
Ascending aorta and/or aortic arch reconstruction by composite valve graft (281, 39%), separate valve graft (117, 16%), graft only (256, 36%), and other procedures (63, 9%) was used for aneurysm or dissection caused by trauma (6), infection (20), aortitis (46), dissection (261: acute 72, chronic 189), and medial degeneration (384) in 717 patients during the 9-year period between Jan. 11, 1980, and Jan. 16, 1989. Of these, 150 had 173 previous heart or aortic operations and needed reoperation for progression or recurrence of aneurysm, rupture, valvular insufficiency, aortocutaneous or aorta-heart chamber fistulas, great vein or airway obstruction, and infection. Concurrent distal aneurysmal disease was present or developed in 267 (37%) patients, being most prevalent in patients with arch involvement (211/395, 53%). ⋯ Late survival rates (Kaplan-Meier) were 66% and 57% at 5 and 7 years. Independent predictors of death were severe aneurysm symptoms, preoperative angina, extent of proximal replacement, associated residual distal aneurysm, balloon pump, renal dysfunction, cardiac dysfunction, and stroke. Five-year survival rates varied with the incidence of the four preoperative variables and age in a single patient: 78% in 413 patients with up to one variables, 57% in 193 patients with two or three, and 39% in 111 patients with three or four (p less than 0.0001).
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Biography Historical ArticleEight former presidents of the AATS. The Boston connection.
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J. Thorac. Cardiovasc. Surg. · Nov 1989
Randomized Controlled Trial Comparative Study Clinical TrialSystemic oxygen uptake during hypothermic cardiopulmonary bypass. Effects of flow rate, flow character, and arterial pH.
A factorial experiment was undertaken to study the effects on systemic oxygen uptake of alteration in flow rate between 1.5 and 2.0 L.min-1.m-2, flow character between nonpulsatile or pulsatile perfusion, and acid-base management between attempted pH and alpha stat control during hypothermic cardiopulmonary bypass. Twenty-four patients undergoing elective coronary bypass were studied. After 10-minute periods of stability at moderate hypothermia (28 degrees +/- 1 degrees C), blood samples were aspirated from the arterial and venous lines. ⋯ Lactate concentrations were unaffected by flow rate, flow character, or arterial pH, but there was a small but significant overall decrease during the course of cardiopulmonary bypass (p less than 0.05). Reasons why systemic oxygen uptake was affected by flow rate but not by flow character or arterial pH are discussed. A flow rate of 1.5 L.min-1.m-2 during cardiopulmonary bypass with moderate hypothermia results in a less than maximal systemic oxygen uptake.