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Standard Cardiopulmonary Bypass (standard + cardiopulmonary_bypass)
Selected AbstractsSurgical Approach to the Management of Cardiovascular EchinococcosisJOURNAL OF CARDIAC SURGERY, Issue 3 2009Kutay Tasdemir M.D. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important. Methods: We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years. Results: The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence. Conclusions: Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk. [source] Does Off-Pump Revascularization Reduce Coronary Endothelial Dysfunction?JOURNAL OF CARDIAC SURGERY, Issue 5 2004Harold L. Lazar M.D. This experimental study sought to determine whether OPCAB reduces endothelial dysfunction, compared to standard cardiopulmonary bypass (CPB) with and without the anticomplement agent soluble complement receptor-1 (sCR1). Methods: In 10 pigs, OPCAB was simulated by snaring the left anterior descending (LAD) artery for 15 minutes followed by 3 hours of reperfusion. On-pump revascularization was simulated in 20 pigs by 15 minutes of LAD occlusion on CPB with cold blood cardioplegic arrest followed by 3 hours of reperfusion. Ten of these animals received sCR1 (10 mg/kg) prior to CPB. Inflammatory response was monitored by percent (%) lung water increase, wall motion scores (WMS) with transthoracic echocardiography where 4 = normal to ,1 = dyskinesia, and endothelial function in the distal LAD with bradykinin-induced coronary artery relaxation using organ chamber methodology. Results: OPCAB had no effect on lung edema (% increase = 1.7 ± 1.4 OPCAB vs. 3.4 ± 0.5 CPB vs. 2.3 ± 0.9 CPB + sCR1) and failed to prevent wall motion changes (WMS = 2.65 ± 0.08 OPCAB vs. 2.70 ± 0.04 CPB vs. 3.10 ± 0.07* CPB + sCR1, *p < 0.01) and coronary endothelial dysfunction (% relaxation = 41 ± 9 OPCAB vs. 40 ± 9 CPB vs. 78 ± 8** CPB + sCR1, **p < 0.001), which was best preserved with sCR1. Conclusions: This study suggests that agents which directly inhibit complement activation such as sCR1 are more important in preventing endothelial dysfunction during coronary revascularization than merely avoiding CPB. [source] Optimizing the Circuit of a Pulsatile Extracorporeal Life Support System in Terms of Energy Equivalent Pressure and Surplus Hemodynamic EnergyARTIFICIAL ORGANS, Issue 11 2009Choon Hak Lim Abstract:, The nonpulsatile blood flow obtained using standard cardiopulmonary bypass (CPB) circuits is still generally considered an acceptable, nonphysiologic compromise with few disadvantages. However, numerous reports have concluded that pulsatile perfusion during CPB achieves better multiorgan response postoperatively. Furthermore, pulsatile flow during CPB has been consistently recommended in pediatric and high-risk patients. However, most (80%) of the total hemodynamic energy generated by a pulsatile pump is absorbed by the components of the extracorporeal circuit and only a small portion of the pulsatile energy is delivered to the patient. Therefore, we considered that optimizations of CPB unit and extracorporeal life support (ECLS) system circuit components were needed to deliver sufficient pulsatile flow. In addition, energy equivalent pressure, surplus hemodynamic energy, and total hemodynamic energy, calculated using pressure and flow waveforms, were used to evaluate the pulsatilities of pulsatile CPB and ECLS systems. [source] Reduction of Early Postoperative Morbidity in Cardiac Surgery Patients Treated With Continuous Veno,Venous Hemofiltration During Cardiopulmonary BypassARTIFICIAL ORGANS, Issue 8 2009Remo Luciani Abstract Cardiac surgery with cardiopulmonary bypass is associated with a systemic inflammatory response syndrome. The major clinical features of this include a reduction of pulmonary compliance and increased extracellular fluids, with increased pulmonary shunt fraction similar to acute respiratory distress syndrome, thus resulting in prolonged mechanical ventilation time (VAM) and intensive care unit length of stay (ICU STAY). We evaluated the feasibility of an intraoperatory cardiopulmonary bypass (CPB) circuit connected with a monitor for continuous veno,venous hemofiltration (CVVH) to ameliorate pulmonary function after open heart surgery reducing VAM and ICU STAY. Forty patients undergoing elective coronary artery bypass grafting were randomized at the time of surgery into a control group (20 patients who received standard cardiopulmonary bypass) and a study group (20 patients who received CVVH during cardiopulmonary bypass). The analysis of postoperative variables showed a significative reduction of VAM in treated group (CVVH group mean 3.55 h ± 0.85, control group 5.8 h ± 0.94, P < 0.001) and ICU STAY (CVVH group mean 29.5 h ± 6.7, control group 40.5 h ± 6.67, P < 0.001). In our experience, the use of intraoperatory CVVH during cardiopulmonary bypass is associated with lower early postoperative morbidity. [source] | ||||||||||