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ABSTRACT: Desmopressin acetate (DDAVP) has been implicated as a promising agent to reduce blood loss in patients undergoing cardiopulmonary bypass.
The effects of intraoperative desmopressin were studied in 66 patients undergoing coronary artery bypass grafting, randomized equally into desmopressin and control groups. The desmopressin group received 0.3 microg/kg desmopressin at the end of cardiopulmonary bypass.
Fibrinogen level of both groups significantly reduced at postoperative 2nd hr, whereas a significant rise was observed at postoperative 24th hr with an intergroup difference favoring the control group (p=0.0307). In the desmopressin group, the activation time of factor VIII shortened during the whole postoperative period being significant (p=0.0127) at postoperative 24th hr. Postoperative von Willebrand factor (vWF) levels of the desmopressin group were significantly higher than the preoperative ones. The control group did not show such important changes in factor VIII and vWF measurements. Platelet aggregation times of both groups prolonged at postoperative 2nd hr. The control group showed significant elevation in ADP induced aggregation time at 2nd hr and significant reductions of platelet activation percentage in response to ADP, epinephrine, collagen and ristocetin at 2nd hr. Postoperative blood loss as well as blood transfusion need did not differ between the two groups.
Despite the improved platelet functions, desmopressin does not seem to have obvious beneficial effects on postoperative hemostasis in patients without any bleeding disorder and undergoing elective cardiac surgery.
The Journal of cardiovascular surgery 01/2002; 42(6):741-7. · 1.56 Impact Factor
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ABSTRACT: With broader indications for renal transplantation and improved allograft survival, it is anticipated that the problem of aortic disease in the post-transplant patient will be encountered with increasing frequency. We report a technique of protecting the transplant kidney from ischemic damage during distal aortic surgery. A 30-year-old renal transplant patient who had undergone an operation for ruptured chronic type III dissection 3 years previously underwent abdominal aortic aneurysm repair under hypothermic circulatory arrest. The patient recovered uneventfully and is presently doing well 1 year after the operation. Hypothermic circulatory arrest could be used in selected cases as a useful alternative for transplant kidney protection.
Annals of Vascular Surgery 10/2001; 15(5):575-7. · 1.03 Impact Factor
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ABSTRACT: small arterial defects resulting from either trauma or resection of an aneurysm often present difficult problems to the vascular surgeon.
to demonstrate that certain arterial gaps as a result of traumatic injury or aneurysm resection could be closed with acute intraoperative arterial elongation. Materials: fifteen mongrel dogs underwent acute intraoperative arterial elongation of the right superficial femoral artery, with the left side used for a control vessel.
arterial defects created surgically (median 50 (range 25 to 60 mm) mm). Appropriate length of artery was then undermined. A Foley catheter was placed proximally and distally directly beneath this undermined portion of vessel. The vessel is lengthened following 3 expansion/relaxation cycle of Foley catheter. Arterial gaps were closed by end to end anastomosis. Arterial pressure study was performed in all vessels.
acutely, arterial pressure differences proximal and distal to the anastomosis were seen only when arterial gaps were exceeded 55 mm. There was no occlusion either acutely or after 4 weeks follow-up period. Light microscopic examination of arterial specimens revealed partial disruption of internal elastic lamina. At the end of the follow-up period, formation of neointima with regeneration of the internal elastic lamina was demonstrated. Scanning electron microscopy revealed minimal endothelial denudation.
we believe that, acute intraoperative elongation can be used as an alternative technique to vein grafting for the repair of small traumatic arterial defects in selected cases.
European Journal of Vascular and Endovascular Surgery 08/2001; 22(1):44-7. · 2.99 Impact Factor
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Journal of Thoracic and Cardiovascular Surgery 06/2001; 121(5):987-9. · 3.41 Impact Factor
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ABSTRACT: Mortality and major complications during primary coronary artery bypass operation has decreased substantially during the past 20 years. However, patients undergoing reoperative myocardial revascularization still face markedly elevated perioperative mortality and morbidity. On the other hand, the incidence of reoperative coronary bypass surgery continues to increase. Aggressive perioperative care and optimal myocardial protection is mandatory in these patients. In this article we reviewed the patient profiles, indications for operation, operative techniques and their impact on the surgical results for patients undergoing reoperative coronary artery bypass surgery.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 04/2001; 1(1):35-42, AXIV. · 0.44 Impact Factor
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ABSTRACT: The aim of this prospective study was to determine whether aortic atherosclerotic plaques are associated with increased frequency of microembolic signals and stroke in patients who undergo coronary artery bypass grafting. A total of 69 such patients were monitored by transcranial Doppler ultrasonography for 30 minutes before and after surgery. To our knowledge, this study is the 1st in which in vivo pathologic analysis of aortic plaques was systematically performed-and microembolic signals monitored-before and after open-heart surgery. Plaques were assessed by transesophageal echocardiography and by biopsy of materials taken during surgery. The frequency of microembolic signals was evaluated with regard to the occurrence of postoperative stroke. In the preoperative phase, only 10 of 48 patients with aortic plaques had microembolic signals, and the mean count of microembolic signals was 3.2 +/- 1.2 per hour. At the conclusion of 24 postoperative hours, 29 patients (42%) displayed such signals (mean count, 9.8 +/- 3.1/h). Seven of the 48 patients (15%) with aortic atherosclerosis had cerebral ischemic events, but none of those with normal aorta (21 patients) experienced stroke during the postoperative phase. During postoperative monitoring, patients with stroke had higher microembolic-signal counts than did those with normal aorta (174 +/- 3.3/h vs 5.9 +/- 3.1/h; P <0.05). Our findings suggest that microembolic signals can be a marker of severe aortic atherosclerosis and that monitoring these signals should enable the application of appropriate surgical methods to coronary artery bypass patients who are at higher risk of stroke.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/2001; 28(1):16-20. · 0.65 Impact Factor
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ABSTRACT: Cardiopulmonary bypass increases the blood levels of various immune mediators, thereby leading to a systemic inflammatory response syndrome, e.g. sepsis, with some hemodynamic alterations, such as vasodilatation, tachycardia, and a decrease in systemic vascular resistance. Perioperative hemofiltration is one of the treatment modalities proposed to prevent this syndrome. Modified hemofiltration has been introduced recently by investigators who recommend that the former standard techniques are ineffective in eliminating the inflammatory mediators. The purpose of this study was to determine the effects of the modified technique on these mediators and on hemodynamic parameters. Forty patients undergoing coronary artery bypass grafting were randomized into equal control and hemofiltered groups. The hemodynamic parameters, as well as blood samples, were taken before and after hemofiltration to assess blood concentrations of interleukin-6, interleukin-8 and neopterin. The hemodynamic parameters and immune mediator levels did not differ between the two groups during the course of the study, except in the immediate postoperative periods, where cardiac output, cardiac index, and systemic vascular resistance values were significantly greater in the hemofiltered group while there were no differences in the immune mediators. The results of our study suggest that the effects of modified hemofiltration on immune mediators are still debatable. The improvement found in cardiac performance could be attributed to the prevention of hemodilution and hypervolemia.
Perfusion 04/2000; 15(2):143-50. · 0.92 Impact Factor
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ABSTRACT: Renal failure is known to increase the morbidity and mortality in patients undergoing cardiac surgery. The results of heart surgery in patients with non-dialysis-dependent, mild renal insufficiency are not clear.
One hundred nineteen adult patients with chronic renal failure underwent cardiac surgery. Group I consisted of 93 patients who had creatinine levels between 1.6 and 2.5 mg/dL but who were not supported by dialysis. Group II consisted of 18 patients with creatinine levels higher than 2.5 mg/dL who were not supported by dialysis. Group III consisted of 8 patients with end-stage renal disease who were receiving hemodialysis.
The hospital mortality rates were 11.8%, 33.0%, and 12.5%, respectively. Morbidity was 21.5%, 44.4%, and 75.0%, respectively, in groups I, II, and III. Postoperative hemodialysis was needed in 2 (2.15%) patients from group I and 6 (33%) patients from group II. On multivariable logistic regression analysis, risk factors for mortality were preoperative creatinine level more than 2.5 mg/dL, angina class III-IV, emergency operation, excessive mediastinal hemorrhage, postoperative pulmonary insufficiency, low cardiac output, and rhythm disturbances. Risk factors for morbidity were preoperative creatinine level more than 2.5 mg/dL and postoperative dialysis.
Chronic renal failure increases the mortality and morbidity in patients undergoing cardiac surgery. Renal insufficiency with creatinine levels higher than 2.5 mg/dL increases the risk of postoperative dialysis and prolongs the length of hospital stay. Careful preoperative management and intraoperative techniques, such as avoiding low perfusion pressure and using low-dose dopamine, may be useful for a good operative outcome.
Journal of Thoracic and Cardiovascular Surgery 09/1999; 118(2):306-15. · 3.41 Impact Factor
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ABSTRACT: In the surgical treatment of abdominal aortic aneurysm, the single proximal cross-clamp can be placed at 3 alternative aortic levels: infrarenal, hiatal, and thoracic. We performed this retrospective study to evaluate the advantages and disadvantages of the 3 main aortic clamping locations. Eighty patients presented at our institution with abdominal aortic aneurysms from March 1993 through May 1998. Fifty of these patients had intact aneurysms and underwent elective surgery, and 30 had ruptured aneurysms that necessitated emergency surgery. Proximal aortic clamping was applied at the infrarenal level in 24 patients (22 from the intact aneurysm group, 2 from the ruptured group), at the hiatal level in 34 patients (22 intact, 12 ruptured), and at the thoracic level (descending aorta) via a limited left lateral thoracotomy in 22 patients (6 intact, 16 ruptured). Early mortality rates (within 30 days) were 4% (2 of 50 patients) among patients with intact aneurysms and 40% (12 of 30 patients) among those with ruptured aneurysms. In the 2 patients from the intact aneurysm group, proximal aortic clamps were applied at the hiatal level. In the ruptured aneurysm group, proximal aortic clamps were placed at the thoracic level in 10 patients, the infrarenal level in 1, and the hiatal level in 1. According to our study, the clinical status of the patient and the degree of operative urgency--as determined by the extent of the aneurysm--generally dictate the proximal clamp location. Patients who present with aneurysmal rupture or hypovolemic shock benefit from thoracic clamping, because it restores the blood pressure and allows time to replace the volume deficit. Infrarenal placement is advantageous in patients with intact aneurysms if there is sufficient space for the clamp between the renal arteries and the aortic aneurysm. In patients with juxtarenal aneurysms, hiatal clamping enables safe and easy anastomosis to the healthy aorta. Clamping at this level also helps prevent late anastomotic aneurysm formation, which is frequently encountered after inadvertent anastomosis of the graft to a diseased portion of the aorta. Further studies are needed in order to confirm these results.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/1999; 26(4):264-8. · 0.65 Impact Factor
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ABSTRACT: The aim of this study was to determine the relationship between splanchnic perfusion and oxygen consumption, and flow types in cardiopulmonary bypass (CPB), by measuring gastric intramucosal pH. Twenty patients undergoing elective open-heart surgery were prospectively randomized to receive either pulsatile or nonpulsatile flow during CPB. Gastric intramucosal pH was measured using gastric tonometry. A flowmeter was used to measure the inferior caval vein flow. A catheter was inserted through the femoral vein to sample blood from the iliac vein. Systemic vascular resistance index, gastric intramucosal pH, inferior caval vein flow and arterial, inferior vena caval and iliac venous blood gases were recorded at different times. Gastric intramucosal pH decreased in all patients; only in the nonpulsatile group was this decrease statistically significant. After 45 min of CPB, the pH was 7.37 +/- 0.03 compared with the prebypass value of 7.48 +/- 0.04 (p = 0.00016). After weaning from CPB, the pH was 7.358 +/- 0.02 compared with the prebypass value (p = 0.000037). At 2 h post-operatively the pH was 7.416 +/- 0.025 (p = 0.02). Systemic vascular resistance index rose in all patients during bypass in both groups. These changes did not have any statistical significances and after weaning from bypass returned to prebypass levels. We conclude that nonpulsatile flow in CPB is associated with reduced gastric intramucosal pH and the measurement of intramucosal pH during open-heart surgery provides important information about splanchnic perfusion.
Perfusion 03/1998; 13(2):129-35. · 0.92 Impact Factor
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ABSTRACT: Although it is a rare occurrence, aortic dissections can rupture into the cardiac chambers or great vessels. A review of the English literature revealed only 3 cases of fistula between an aortic false lumen and the main pulmonary artery that were repaired successfully. In this article, we report the case of a chronic type I aortic dissection with an aortopulmonary artery fistula. The patient presented with congestive heart failure. One year earlier he had undergone aortic valve replacement. To our knowledge, this is the 4th case of a successfully repaired type I aortic dissection with rupture into the pulmonary artery and the 1st such case involving a patient who had undergone a previous cardiac operation.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/1998; 25(1):72-4. · 0.65 Impact Factor
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ABSTRACT: We reviewed the cases of 69 consecutive patients who underwent physiologic reconstruction of the left ventricular cavity with an endoventricular patch (endoaneurysmorrhaphy) after aneurysmectomy. Eight patients had isolated endoaneurysmorrhaphy, 60 patients had concomitant coronary artery bypass grafting, and 1 patient had concomitant closure of an atrial septal defect. The primary indications for operation were angina pectoris (New York Heart Association functional class I or II) in 42 patients and dyspnea (functional class III or IV) in 27 patients. The preoperative left ventricular ejection fraction evaluated with ventriculography was 28.95% +/- 7.27% (mean +/- standard error of the mean). The global perioperative mortality rate was 2.8%. Total follow-up was 139.3 patient-years. The late mortality rate was 4.3% per patient-year. A marked increase was found in the mean postoperative left ventricular ejection fraction of the patients: 41.91% +/- 11.83%. Survivors were interviewed in person: their functional status was class I or II in 58 patients and class III in 3 patients. We conclude that left ventricular endoaneurysmorrhaphy results in satisfactory functional improvement and can be performed with relatively low early and late mortality rates.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 02/1996; 23(3):207-10. · 0.65 Impact Factor
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ABSTRACT: Aneurysms and dissections of the thoracic aorta continue to present a surgical challenge and their incidence is increasing in recent years. The mortality rate of surgical treatment is still higher than those of other cardiovascular operations. Neurological injury is the most feared complication resulting from repair of these lesions. This study aims to determine the factors that influence the neurological outcome and mortality after thoracic aortic operations.
During the period from November 1993 through May 1999, 144 patients were operated on for conditions involving the ascending aorta and/or aortic arch. Ninety-five (66.0%) were operated for aortic dissection and 49 (34.0%) were for aortic aneurysms. Sixty-two patients (43.1%) had replacement of ascending aorta with distal open technique; 82 patients (56.9%) had hemiarch or total arch replacement or repair of the distal arch.
Twenty-seven (18.7%) early deaths occurred. New stroke occurred in two patients (1.4%) and temporary neurological dysfunction in nine patients (6.3%). Deep hypothermic circulatory arrest with retrograde cerebral perfusion was used in all patients. On multivariate logistic regression analysis, risk factors for mortality were chronic renal failure, preoperative organ malperfusion, rupture, total circulatory arrest time > 60 minutes, postoperative acute renal failure, postoperative low cardiac output, sepsis, and multiple organ failure. Risk factors for neurological morbidity were preoperative chronic renal failure, preoperative hemodynamic instability, postoperative low cardiac output, and pulmonary complications.
Hypothermic circulatory arrest with retrograde cerebral perfusion was not an independent predictor of neurological morbidity on multivariate analysis, even if the arrest period was more than 60 minutes. Lengths of circulatory arrest periods and clinical presentations of the patients are important determinants of mortality.
Journal of Cardiac Surgery 15(3):186-93. · 0.87 Impact Factor
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ABSTRACT: Primary spontaneous coronary artery dissection is an unusual occurrence. There have been less than 150 cases reported in world literature. This process frequently occurs in relatively young women, particularly in the peripartum or early postpartum period. This article reports the clinical course of one patient with primary spontaneous left main coronary artery dissection who was treated with coronary artery bypass grafting. To our knowledge, it is the second case to be treated with the use of left internal mammary artery.
Journal of Cardiac Surgery 11(5):371-5. · 0.87 Impact Factor
