The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jun 1985
Phrenic nerve paresis associated with the use of iced slush and the cooling jacket for topical hypothermia.
Phrenic nerve injury has been reported with the use of iced slush for topical cardiac hypothermia. To study this problem in both valve and coronary procedures, we tried to detect phrenic nerve injury in five groups of patients undergoing cardiac operations in which different techniques of topical hypothermia were used. ⋯ Phrenic paresis is transient and of no clinical significance except when bilateral. Avoidance of contact of either the cooling jacket or iced slush with the phrenic nerve could avoid this complication.
-
J. Thorac. Cardiovasc. Surg. · May 1985
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass.
The ideal priming fluid for cardiopulmonary bypass is not known. We designed a study to determine whether there are important differences in the clinical effects of hydroxyethyl starch versus albumin when used in priming fluid, and in the clinical effects of colloid versus crystalloid priming fluid. We prospectively randomized 83 adult patients undergoing coronary artery bypass or valve replacement. ⋯ No adverse reaction to the prime solutions was noted. The differences between the HES and ALB groups--prothrombin time, platelet count, and blood viscosity--had no apparent clinical effects; thus, the two may be considered clinically equivalent. The greater somatic and pulmonary fluid accumulation in the LRS group suggests that colloid is preferable to crystalloid in priming fluid.
-
J. Thorac. Cardiovasc. Surg. · May 1985
Cardiovascular and thoracic battle injuries in the Lebanon War. Analysis of 3,000 personal cases.
This report comprises 3,000 casualties of the Lebanon War whom I operated upon for cardiovascular-thoracic injuries in twelve Lebanese hospitals between January, 1969, and July, 1982. These patients were studied retrospectively through 1978 and prospectively thereafter. The logistics, weapons, wounds, and operative results in this study were unique. ⋯ The mortality for injury to the aorta was 60% (12 deaths), contrasted with 1% (three deaths) for injury to extremity vessels. Hemorrhage and cardiac rupture were the most frequent causes of death. Early, proficient, open surgical control after or concomitant with intensive resuscitation proved successful in this special military conflict.
-
J. Thorac. Cardiovasc. Surg. · Mar 1985
Comparative StudyIn vivo hemodynamic comparison of porcine and pericardial valves.
The bovine pericardial valve and the SupraAnnular valve have been developed to improve the hemodynamic function of tissue valves. Hemodynamic performances of the standard Carpentier-Edwards porcine valve, the Carpentier-Edwards SupraAnnular valve, and the Carpentier-Edwards bovine pericardial valve were compared in the aortic position. One hundred patients undergoing aortic valve replacement were studied intraoperatively. ⋯ At the same flow rate, the 23 mm pericardial valve had larger valve orifice areas, higher performance indices, and lower gradients than the 23 mm SupraAnnular valve. The SupraAnnular valve is hemodynamically superior to the standard Carpentier-Edwards porcine bioprosthesis. The Carpentier-Edwards pericardial valve, however, is less obstructive in the aortic position than either of the porcine valves.
-
J. Thorac. Cardiovasc. Surg. · Feb 1985
Indications for ultrafiltration in the cardiac surgical patient.
Ultrafiltration is an extracorporeal technique that employs the principle of convective solute transport across a semipermeable membrane and by which plasma water is removed from blood. Ultrafiltration has been employed in 74 cardiac surgical patients intraoperatively, preoperatively, and postoperatively. In 55 patients with clinical evidence of excess body water, the ultrafilter was employed at the start of cardiopulmonary bypass. ⋯ One patient underwent slow continuous ultrafiltration for severe, diuretic-resistant congestive heart failure postoperatively. After 9 days of ultrafiltration, there was an 8 kg weight loss, an improvement in congestive heart failure, and a return of the response to diuretics. From this experience my colleagues and I have developed the following indications for ultrafiltration in the cardiac surgical patient: during cardiopulmonary bypass to prevent further fluid accumulation in the patient with clinical evidence of excess body water; during bypass to prevent excess fluid balance in a patient whose bypass time will be greater than 2 hours; during bypass when the pump reservoir volumes are excessive and/or the hematocrit is less than 18%; preoperatively or postoperatively to increase caloric intake in the fluid-overloaded patient; and preoperatively or postoperatively to reverse severe congestive heart failure in the diuretic-resistant patient.