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ABSTRACT: OBJECTIVES The optimal temperature for blood cardioplegia remains unclear. METHODS A retrospective analysis was performed on 138 patients undergoing isolated myocardial revascularization by a single surgeon in our institution over a period of 2 years. Patients operated on early in the study period received tepid (29°C) continuous minimally diluted blood cardioplegia (minicardioplegia), delivered in an antegrade continuous fashion. Later, our surgeon began using cold (7°C) blood minicardioplegia in all patients. Data pertaining to clinical outcomes and postoperative biochemical data were obtained, and the two groups were compared. RESULTS Low cardiac output syndrome, defined as the need for intra-aortic balloon pump counter pulsation or inotropic medication for haemodynamic instability, was more frequent in the tepid cardioplegia group than in the cold cardioplegia group (16.0 vs 2.4%, P = 0.006). There was no difference in the maximal serum creatine kinase MB between the two groups (cold 25.4 ± 3.21 μg/ml vs tepid 36.5 ± 7.10 μg/ml, P = 0.62), in the rates of perioperative myocardial infarction (cold 1.2% vs tepid 6.0%, P = 0.15) and the need for postoperative insertion of an intra-aortic balloon pump (cold 4.8% vs tepid 0.0%, P = 0.3). There was no other statistically significant difference between the two groups in the measured parameters. CONCLUSIONS A higher rate of low cardiac output syndrome in the tepid cardioplegia group suggests inferior myocardial protection with the tepid cardioplegia. Cold cardioplegia may provide better protection than tepid cardioplegia when minicardioplegia is used.
Interactive cardiovascular and thoracic surgery 06/2012; 15(4):655-60.
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The Annals of thoracic surgery 02/2011; 91(2):443-4. · 3.74 Impact Factor
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European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2010; 38(4):504. · 2.40 Impact Factor
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ABSTRACT: Cardiogenic shock resulting from transplant rejection is a serious complication with high mortality and morbidity. Often resistant to maximal medical therapy, this condition frequently requires mechanical circulatory support until recovery or retransplantation. We present a 52-year-old patient with multiorgan failure secondary to acute graft rejection after orthotopic heart transplantation. Maximal medical therapy was not successful, and the patient was bridged to recovery with an Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD). The relative merits of this therapeutic approach are outlined and discussed. The patient was discharged 3 weeks after LVAD removal and remains clinically stable.
The Annals of thoracic surgery 08/2009; 88(1):271-3. · 3.74 Impact Factor
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ABSTRACT: Multi-organ failure (MOF) secondary to bi-ventricular cardiac dysfunction is a major therapeutic challenge. In addition to aggressive medical therapy, it frequently requires circulatory support with uni- or bi-ventricular assist devices. The Impella LP 5.0 is a new microaxial left ventricular assist device (LVAD). Microaxial LVADs have been used for short-term circulatory support in patients with cardiogenic shock due to myocarditis, post coronary artery bypass grafting (CABG), or during high-risk percutaneous coronary interventions (PCI). We present a case of a patient in bi-ventricular failure successfully bridged to permanent circulatory support. Relative merits of this therapeutic approach are outlined and discussed.
Interactive cardiovascular and thoracic surgery 04/2009; 8(6):682-3.
