The heart surgery forum
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The heart surgery forum · Jan 2001
Comparative StudyReoperative coronary artery bypass grafting with and without cardiopulmonary bypass: determinants of perioperative morbidity and mortality.
This retrospective study evaluates perioperative results of reoperative coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB). ⋯ Avoidance of CPB independently reduces adverse outcomes in reoperative CABG without affecting mortality rate.
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The heart surgery forum · Jan 2001
Correction of congenital heart defects and mitral valve operations using limited anterolateral thoracotomy.
Median sternotomy, which generally is used as a standard access for atrial septal defect (ASD) and mitral valve operations, has a significant risk of postoperative instability/osteomyelitis of the sternum. Moreover, especially in young women, the resulting large scar is a poor cosmetic result that may have adverse psychological consequences. Our presentation suggests that these difficulties may be avoided by the use of a less invasive approach consisting of a limited anterolateral thoracotomy with standard cannulation. ⋯ Atrial septal defect operations, including partial anomalous pulmonary venous connection, left atrial myxoma and mitral valve operations, can be performed safely and effectively using a limited anterolateral thoracotomy and standard cannulation technique with excellent cosmetic results.
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The heart surgery forum · Jan 2001
ReviewStress and inflammatory response after beating heart surgery versus conventional bypass surgery: the role of thoracic epidural anesthesia.
Cardiac surgery elicits a cascade of stress responses mediated by the release of various cytokines and stress hormones [Roth-Isigkeit 1998]. Apart from the stress induced by the surgical process, cardiopulmonary bypass (CPB) has been documented to play a major role in the perioperative stress response seen following cardiac surgery [Butler 1993, McBride 1995, Hall 1997]. The imbalance in pro- and anti-inflammatory responses may affect outcome in cardiac surgery patients [Casey 1993, McBride 1995, Menasch 1995]. ⋯ Beating heart surgery done without the aid of CPB significantly attenuates cytokine and stress response [Brasil 1998, Fransen 1998, Gu 1998, Wan 1999b, Ganapathy 1999a, Ganapathy 2000a]. There is reduced renal dysfunction following beating heart surgery [Ascione 1999], which may be related to reduced proinflammatory cytokine surge. Thoracic epidural analgesia inhibits intraoperative cortisol as well as catecholamine surge but does not add further to the reduction in cytokine response [Ganapathy 1999b].
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The heart surgery forum · Jan 2001
A cytokine analysis of the effect of cell saver on blood in coronary bypass surgery.
Increasing concern about the transmission of viral disease has generated greater interest in the use of salvaged blood as a means of alleviating the demand for homologous blood and expediting resuscitation during massive hemorrhage. Autologous blood processed by autotransfusion devices has become increasingly common in major surgery and is now largely viewed as safe and efficacious. However, there may be serious complications and sequelae associated with the use of processed blood, such as adult respiratory distress syndrome (ARDS) and renal failure. Complement cascade activation resulting from blood coming into contact with autotransfusion equipment leads to enrollment of leukocytes and release of large concentrations of cytokines, which may contribute to the development of organ failure. Our study evaluated cytokine release during cell saver (CS) blood salvage in the course of coronary artery bypass grafting (CABG) surgery. ⋯ Statistically significant increases in both the circulating levels of the pro-inflammatory and anti-inflammatory cytokines studied were recorded. It is our contention that the presence of IL-10, a down-regulator of inflammation, is responsible for attenuating the possible deleterious effects of the pro-inflammatory cytokines observed. However, morbidity and mortality, as well as the future patency of the bypass grafts, have not been correlated with the use of the autologous method of transfusion.
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The heart surgery forum · Jan 2001
OPCAB therapy survey: off-pump clopidogrel, aspirin or both therapy survey.
Standards for heparinization during off-pump coronary artery bypass (OPCAB) are lacking. Similarly, there are no established standards for antiplatelet therapy before or after OPCAB. The aim of this study was to determine current practices and standards for both antiplatelet and heparin therapy in OPCAB. ⋯ Although the vast majority of surgeons use antiplatelet therapy postoperatively, a minority administer preoperative antiplatelet agents for OPCAB. The majority of surgeons use a half dose of heparin during OPCAB with ACT maintained above 300 seconds (> 80%). Prospective studies are necessary to determine the short and intermediate effects of antiplatelet therapy and heparinization doses in OPCAB surgery.