The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 1986
Retained intracardiac air. Transesophageal echocardiography for definition of incidence and monitoring removal by improved techniques.
Retained intracardiac air is a continuing hazard for cardiopulmonary bypass. M-mode transesophageal echocardiography of the left atrium, left ventricle, and aorta is a highly sensitive method for detecting retained intracardiac air bubbles. In 15 patients having valve operations and 18 having coronary bypass, M-mode transesophageal echocardiography was used to record air bubbles during and for 15 minutes after bypass. ⋯ There are three essential elements of air removal: First is mobilization of the air; positive chamber filling, stretching of the atrial wall, and ballottement are critical. Second is removal of mobilized air; continuous ascending aorta-venous shunting and nonsuction venting of the left atrium are very important. Third is proof of elimination of air before cardiopulmonary bypass is terminated; transesophageal echocardiography is vital for this.
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J. Thorac. Cardiovasc. Surg. · Mar 1986
Surgical results for mitral regurgitation from coronary artery disease.
Results of coronary artery bypass grafting with and without mitral valve replacement were analyzed retrospectively in 101 patients with preoperative ischemic mitral regurgitation to determine the effects of severity and surgical treatment of mitral regurgitation on survival. Between 1980 and 1984, a total of 1,475 patients (mean age 59, 77% male) underwent coronary bypass. These patients were divided into three groups: (1) patients without ischemic mitral regurgitation who underwent isolated coronary bypass (1,374; 93%), (2) patients with ischemic mitral regurgitation who underwent isolated coronary bypass without valve replacement (85; 6%), and (3) patients with ischemic mitral regurgitation who underwent combined mitral valve replacement and coronary bypass (16; 1%). ⋯ The actuarial survival rate at 5 years for the coronary bypass patients without ischemic mitral regurgitation was 85% compared to 91% (p less than 0.05) for the coronary bypass patients without ischemic mitral regurgitation. These results indicate that patients with ischemic mitral regurgitation have a higher prevalence of cardiac risk factors and are at an increased risk of operative mortality. Although the severity of the ischemic mitral regurgitation was strongly predictive of early survival, it proved to have an unexpectedly modest effect on long-term survival after surgical treatment.
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J. Thorac. Cardiovasc. Surg. · Mar 1986
Randomized Controlled Trial Clinical TrialA prospective, randomized study of the effects of prostacyclin on platelets and blood loss during coronary bypass operations.
A randomized, double-blind study was designed to evaluate the therapeutic effect and safety of prostacyclin (epoprostenol) in patients undergoing cardiopulmonary bypass. One hundred patients having isolated coronary bypass grafting received 300 units/kg of heparin and then either prostacyclin (12.5 ng/kg/min from heparinization until cardiopulmonary bypass, 25 ng/kg/min during bypass) or buffer/diluent in a similar manner. Standardized anesthetic, perfusion, and surgical techniques were used. ⋯ Prostacyclin may provide clinical benefits in patients undergoing cardiopulmonary bypass when there are contraindications to or other difficulties with blood transfusion. With prostacyclin, reduced heparin dose is possible and therefore reduced protamine requirement would offer a potential benefit of less cardiovascular depression immediately after bypass. However, the advantages offered by prostacyclin are not sufficient to recommend its routine use during cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · Mar 1986
Complications of tracheal reconstruction. Incidence, treatment, and prevention.
Between 1962 and 1982, 416 primary tracheal reconstructions and 21 staged reconstructions were performed. Since then 80 additional tracheal reconstructions have been accomplished (to April of 1985). ⋯ The first and second halves of the series have therefore been compared. Measures to prevent complications are discussed.