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  • 1
    Electronic Resource
    Electronic Resource
    Avoidance of Full-Sternotomy: (2003)
    135 Bedford Road, PO Box 418 , Armonk , NY 10504-0418 USA . : Blackwell Science Inc
    Journal of cardiac surgery 18 (2003), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract  Background and Aim of the Study: Although open heart operations via a mini-sternotomy or mini-thoracotomy are considered “less invasive” cosmetically and are hopeful for early social recovery, clinical experiences have not shown less invasiveness toward systemic inflammatory response, because of the wide variety of patients and operative procedures encountered. We examined the effect of a mini-sternotomy on an inflammatory response during a cardiopulmonary bypass (CPB) procedure performed in rats. Methods: Thirty-two adult Sprague-Dawley (SD) rats, each of which underwent a 120-minute CPB, were randomly divided into four groups according to the method of exposing the pericardial cavity; no sternotomy (Group N[0 cm], n= 8), right para-sternal thoracotomy (Group P [2 cm], n= 8), lower mini-sternotomy (Group M [2 cm], n= 8), and full-sternotomy (Group F [4 cm], n= 8). Blood samples were obtained (1) just prior to the initiation of CPB, and then (2) 30, (3) 60, and (4) 120 minutes after the initiation of CPB. Results: Thirty minutes after the initiation of CPB, there were significant differences in plasma interleukin [IL]-6 levels between groups, except for Groups P and M; whereas at 60 minutes the only significant difference occurred between Groups N and F, and at 120 minutes there were no significant differences between any of the groups. Further, plasma IL-8 levels were not significantly different at each sampling point between all of the groups. Conclusions: These results first demonstrate experimentally that the avoidance of a full-sternotomy can be considered a less invasive strategy in terms of reducing the systemic inflammatory response that accompanies a shorter CPB duration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8191.2003.02046.x
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  • 2
    Electronic Resource
    Electronic Resource
    Improvement of Bypass Circuit Biocompatibility: Comparison and Combination of Heparin-Coated Circuit and Nitric Oxide Gas Infusion (2002)
    Malden, USA : Blackwell Science Inc
    Journal of cardiac surgery 17 (2002), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abstract Objectives: Nitric oxide (NO) gas infusion to the oxygenator, as well as heparin-coated bypass circuits, have been reported to attenuate blood activation induced by the interaction with the artificial surfaces of an extracorporeal bypass circuit. Using a mock circulation model, we compared the effect of each and also evaluated the effect of their combination on attenuating bypass-induced blood activation. Methods: A miniature closed bypass circuit was primed with diluted fresh human blood and perfused for 180 minutes using a centrifugal pump. NO gas (0, 50, or 100 ppm) was infused to the oxygenator sweep gas of either a non-heparin-coated or a heparin-coated circuit. Platelet counts, β-thromboglobulin, platelet factor 4, complement-3 activation products and granulocyte elastase were measured at 0, 30, 60, 120, and 180 minutes after starting the perfusion. Results: One hundred ppm of NO was statistically equivalent to the heparin-coated circuit for attenuating bypass-induced blood activation, and a combination of the two significantly surpassed the results of either modification alone. Fifty ppm of NO alone provided only a slight attenuation of blood activation as compared with the non-heparin-coated circuit, though the difference was not significant. A combination of 50 ppm NO and the heparin-coated circuit did not significantly enhance the effects of the heparin-coated circuit alone. Conclusions: The combination of NO gas infusion and heparin-coated circuits appears to be a useful and promising modification for enhancing the attenuation of bypass-induced blood activation, though the optimal dose of NO infusion in terms of effectiveness and adverse effects to the whole body remains to be established.(J Card Surg 2002;17:477-484)
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1540-8191.2002.01001.x
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  • 3
    Electronic Resource
    Electronic Resource
    Importance of Preoperative Marking for Minithoracotomy and for Internal Thoracic Artery Harvesting in Minimally Invasive Direct Coronary Artery Bypass Grafting (2000)
    Springer
    Surgery today 30 (2000), S. 400-402 
    Details
    ISSN: 1436-2813
    Keywords: Key Words: preoperative marking, minimally invasive direct coronary artery bypass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Minimally invasive direct coronary artery bypass has the potential to cause an anastomotic failure because of a limited exposure of the operative field and the difficulty of internal thoracic artery harvesting. In the present study, the importance of preoperative marking for an accurate minithoracotomy location and a successful internal thoracic artery harvest was assessed. A paperclip was placed on the left nipple and a chest X-ray was performed in the supine position. By aligning the position of the paperclip to the location of the left anterior descending coronary artery from a coronary arteriogram frontal view, the intercostal space for the minithoracotomy was thus determined. Marking the incisional intercostal space during preoperative left internal thoracic arteriography revealed the number and location of the internal thoracic artery branches at the beginning of the harvest. This preoperative marking technique allowed for a more adequate exposure of the operative field and an easier internal thoracic artery harvest which therefore contributed to an improvement in the operative results.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950050611
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  • 4
    Electronic Resource
    Electronic Resource
    Role of nitric oxide in regulation of systemic vascular resistance during and after cardiopulmonary bypass (1999)
    Springer
    Journal of artificial organs 2 (1999), S. 152-156 
    Details
    ISSN: 1619-0904
    Keywords: Nitric oxide ; Cardiopulmonary bypass ; Vasoactive substance ; Systemic vascular resistance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract Cardiopulmonary bypass (CPB) is known to result in the abnormal production of vasoactive substances contributing to the changes in hemodynamics such as systemic vascular resistance (SVR) during and after CPB. Nitric oxide (NO) is an inflammation-mediated vasoactive substance that plays a role in the whole-body inflammatory response induced by CPB. We evaluated the role of NO in the regulation of SVR during and after CPB. Fifteen patients underwent open-heart surgery for valvular heart disease. The perfusate blood temperature of CPB was set to 34°C. The plasma levels of NO metabolites (NO 2 − +NO 3 − ), prostaglandin E2 (PGE2), bradykinin (BK), and systemic vascular resistance index (SVRI) were measured before CPB and 0, 12, and 24 h after CPB. The plasma level of NO metabolites increased gradually after CPB (pre-CPB, 26.3 ±4.4; 0h, 33.7±6.5; 12 h, 49.8±11.1; 24 h, 43.1±7.5 μM). SVRI decreased gradually after CPB (pre-CPB, 2361±364; 0h, 2048±216; 12 h, 1590±308; 24 h, 1727±435 dyne·s·cm−5·m2). There was a significant inverse correlation between SVRI and the plasma level of NO metabolites as a whole (r=−0.674,P〈0.0001). No significant correlations were observed between SVRI and the other vasoactive substances PGE2 and BK. These findings demonstrated that NO production increased gradually during and after CPB in association with the decrease in SVR.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02480059
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  • 5
    Electronic Resource
    Electronic Resource
    Clinical evaluation of centrifugal pump in left heart bypass for patients with postcardiotomy shock (2000)
    Springer
    Journal of artificial organs 3 (2000), S. 154-157 
    Details
    ISSN: 1619-0904
    Keywords: Centrifugal pump ; Heparin-coated circuits ; Ventricular support ; Percutaneous cardiopulmonary support ; Postcardiotomy shock
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract Clinical experience with the use of the centrifugal pump for left heart bypass was reviewed in patients with postcardiotomy shock in an attempt to improve survival. Twenty-one patients who could not be weaned from cardiopulmonary bypass were reviewed. All patients with postcardiotomy heart failure were supported with a centrifugal pump as left heart bypass. The mean duration of support was 102±66 h. Nine patients (43%) needed right heart bypass through the same median sternotomy because of right heart failure. The weaning rate was 67% and the survival rate was 43%. Twelve patients died. Seven patients were not weaned from the device and died of multiple organ failure, including major bleeding in five patients. The other five patients were weaned from the device but died of low cardiac output syndrome (three patients), infection (one patient), and brain death (one patient). The complications related to the device included bleeding in seven patients (33%), of which only one patients survived. Four patients had stroke (19%), and two of them survived. These data demonstrated that postoperative bleeding and stroke were the major factors affecting survival in patients with postcardiotomy heart failure with a centrifugal pump used as left heart bypass.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02479983
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  • 6
    Electronic Resource
    Electronic Resource
    Percutaneous cardiopulmonary support system as a bridge to left ventricular assist system (LVAS) implantation: Analysis of its role in the treatment of end-stage cardiac disease (1998)
    Springer
    Journal of artificial organs 1 (1998), S. 33-36 
    Details
    ISSN: 1619-0904
    Keywords: PCPS ; LVAS ; Heart failure ; Multiple organ failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Technology
    Notes: Abstract The key to the successful implantation of a left ventricular assist system (LVAS) for patients with endstage cardiac disease is whether the functions of other vital organs are irreversibly damaged or not. The percutaneous cardiopulmonary support system (PCPS) is not only equal in convenience to the intra-aortic balloon pump (IABP), it is more powerful in resuscitating impaired end-organ function. To investigate the efficacy of PCPS for end-state cardiac disease, we retrospectively analyzed end-organ function before and after the application of PCPS. From 1992 to 1996, five cardiomyopathy patients with deteriorated end-organ function despite the application of IABP underwent PCPS support before implantation of LVAS. Urine volume and levels of liver enzymes (sAST and sALT) and serum creatinine were determined before and after the application of PCPS. After the application of PCPS, the urine output increased significantly (1840±450 to 4340±470 ml/day,P〈0.01) and levels of sAST, sALT, and serum creatinine decreased significantly (630±220 to 150±50IU/l, 630±260 to 260±130IU/l, and 2.9±0.5 to 1.2±0.1 mg/dl, respectively) (P〈0.05). All five patients were successfully bridged to LVAS implantation and none of them died of multiple organ failure caused by pre-existing cardiac failure although one out of five patients died on device ultimately. These results indicated that PCPS before LVAS implantation is useful to resuscitate impaired end-organ function and to improve the survival rate of LVAS implantation for end-stage cardiac disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01340450
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