The heart surgery forum
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The heart surgery forum · Jan 2006
Controlled Clinical TrialAortic valve replacement in true severe aortic stenosis with low gradient and low ejection fraction.
The results of aortic valve replacement are uncertain among patients with severe aortic stenosis, reduced left ventricular ejection fraction, and low mean transvalvular gradient. The aim of the present study was to report on 27 patients who underwent surgery for aortic stenosis with left ventricular ejection fraction
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The heart surgery forum · Jan 2006
Case ReportsProfound hypothermic cardiac arrest treated successfully using minimally invasive cardiopulmonary bypass: a case report.
Hypothermia is defined as a core temperature of less than 35 degrees C. The decision to resuscitate a hypothermic patient can be difficult, as consideration must be given to whether the patient died before the cooling process. The modality for rewarming must also be considered. ⋯ Cardiopulmonary bypass provides excellent circulatory support for profound hypothermia and allows rapid core rewarming. The femoro-femoral approach is the preferred method for this scenario.
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The heart surgery forum · Jan 2006
Pre-clinical validation of a new intra-operative "dual beam Doppler" blood flowmeter in an artificial circuit.
Intra-operative flow measurement during coronary or peripheral bypass operations is helpful for ruling out technical failures and for prediction of complication and patency rates. Preclinical validation of the flowmeters is required in order to rely on the intra-operatively measured results. The aim of this study is to evaluate a new "dual beam Doppler" blood flowmeter before clinical application and to compare it with the established "transit time flow measure-ment" technique in an artificial circuit. ⋯ All 3 tested flowmeters showed an excellent correlation to the true flow in an artificial circuit and the accuracy of the tested devices was within agreement limits. Reproducibility of all devices was good and linear. The new dual beam Doppler flow measurement technique compares favorably to the classic transit time method. Clinical use may depend on operator, location, and condition, thus more studies may be required to ensure uniform results using the currently available blood flow measurement devices.
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The heart surgery forum · Jan 2006
Randomized Controlled TrialThe changes and effects of the plasma levels of tumor necrosis factor after coronary artery bypass surgery with cardiopulmonary bypass.
Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system, leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins, or by surgical trauma. Proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8, play an important role in the inflammatory processes after CPB and may induce cardiac and lung dysfunction. This study examined the association of the increased release of TNF-alpha with increased myocardial and lung injury after CPB and its effect on postoperative morbidity. ⋯ Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare, but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level, C-reactive protein, and erythrocyte sedimentation rate after the operation, but in patients with a high level of TNF-alpha (more than 20 pg/mL), increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however, the specific level of TNF-alpha was first described as 20 pg/mL in this study.
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The heart surgery forum · Jan 2006
Comparative StudyOpening the cardiac chambers does not make any difference in p300 measurement.
Cognitive brain dysfunction after open heart surgery is a serious complication caused by cardiopulmonary bypass (CPB). The presence of gaseous and/or particulate emboli in the CPB circuit and cerebral hypoperfusion may be the causes of neurologic problems after cardiac operations. ⋯ Postoperative patients had prolonged P300 values according to the preoperative measurements and we have not found any difference between the groups whether cardiac chambers were opened or not.