The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1979
Use of athrombogenic tubing for perfusion rewarming following surface-induced deep hypothermia.
A method of heparinless, oxygenatorless, left heart bypass perfusion rewarming following surface hypothermia, with the use of a closed circuit with 130 ml. prime volume including heat exchanger, has been devised. The use of polyurethane-polyvinyl-graphite (PPG)-coated tubing has previously been reported. In this text, the use of an athrombogenic coating with cetyl-pyridinium chloride (CPC) as a regional heparin carrier was studied in dogs, comparing groups with PPG tubing and total systemic heparinization or plain polyvinyl tubing without systemic heparinization. ⋯ Alterations of hematologic parameters in all three groups were similar to those during surface rewarming except for those affected by heparinization. The left heart bypass method was found useful for hypothermic open-heart surgery when utilized with an athrombogenic surface coating or total body heparinization. It was concluded that the CPC coating is superior to the PPG coating since no cracking surface develops, it is translucent, and it provides a more effective athrombogenic surface.
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J. Thorac. Cardiovasc. Surg. · Feb 1979
Implantation of an endocardial tined lead to prevent early dislodgment.
Early electrode dislodgment from the ventricular apex is a major complication associated with transvenous cardiac pacing. A new lead with flexible tines proximal to the tip electrode has been developed to minimize acute dislodgment incidence. The bipolar tined lead was implanted in 79 patients. ⋯ Although the cephalic vein was the preferred venous route, the jugular vein was needed more often for tined lead insertion than for standard lead insertion. The incidence of early dislodgment with the tined lead was 2.5 percent compared to 8 percent with the standard lead (no significant difference). This preliminary experience can only suggest that the addition of flexible tined leads may reduce early electrode dislodgment.
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J. Thorac. Cardiovasc. Surg. · Feb 1979
Comparative StudyPharmacologic antagonism of beta-adrenergic blockade in dogs. I. Hemodynamic effects of isoproterenol, dopamine, and epinephrine in acute propranolol administration.
Hemodynamic effects of isoproterenol, dopamine, and epinephrine were studied before and after acute beta-adrenergic blockade in 16 open-chest, anesthetized mongrel dogs. Beta blockade was induced with 1 mg. per kilogram of intravenous propranolol. Cardiac output measurements were obtained by thermal dilution, and pressure recordings were obtained in the right ventricle, pulmonary artery, left atrium, left ventricle, and aorta. ⋯ Left ventricular systolic pressure with isoproterenol after propranolol was reduced when compared with effects of smaller doses prior to propranolol. These observations suggest that none of the catecholamines studied would be optimal for circulatory support in heart failure in the presence of propranolol. The present results define a pharmacologic basis for design of appropriate drug combinations for circulatory support in beta-blocked animals.
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J. Thorac. Cardiovasc. Surg. · Dec 1978
Comparative StudyNon--cloth-covered caged-ball prostheses. The second decade.
The Starr-Edwards Models 6120 mitral and 1200/60 aortic valves are caged-ball prostheses with cloth-covered sewing rings and bare-metal struts. Introduced in 1965, they have been in continuous clinical use longer than any other currently available heart valve prostheses. Late results with this valve are analyzed and compared with recent series employing other current valve prostheses. ⋯ There was one anticoagulant-related death in 1,698 patient-years of follow-up. The current non--cloth-covered caged-ball valves provide unquestionable durability and well-documented results into their second decade of use. They provide a base line for comparison with newer prostheses and offer a valid, current choice for both aortic and mitral valve replacement.
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J. Thorac. Cardiovasc. Surg. · Nov 1978
Physicians' assistants on a university cardiothoracic surgical service. A five-year update.
In 1973 two physicans' assistants (P. A.'s) were employed on a cardiothoracic surgical service at Emory University Hospital. In 1974 our initial experience with these paramedical personnel was presented to this Association. ⋯ This report details our experience with P. A.'s for the past 5 years--culminating in a staff of ten P. A.'s working on our service in four types of hospitals within our university medical center.