Assuntos
Alopurinol/uso terapêutico , Doença das Coronárias/tratamento farmacológico , Alopurinol/administração & dosagem , Animais , Débito Cardíaco/efeitos dos fármacos , Angiografia Coronária , Cães , Feminino , Fluoresceínas/administração & dosagem , Coração/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica/efeitos dos fármacos , Injeções Intravenosas , Masculino , Fatores de Tempo , Resistência Vascular/efeitos dos fármacosRESUMO
Controversy continues about the oxygenator preferable for cardiopulmonary bypass (CPB). This prospective study was undertaken in 52 patients undergoing coronary bypass surgery. Oxygenators were alternated each case between model Q-100, Bentley Laboratories Inc, Irvine, Calif, and Travenol Membrane Oxygenator (TMO), Travenol Laboratories Inc, Deerfield, Ill. The Q-100 group required higher CPB O2 flows, but PO2 levels during CPB were similar for both groups. Heparin sodium dosage and activated clotting, bleeding, prothrombin, and partial thromboplastin times were identical in both groups. Blood loss and platelet reduction after CPB were also similar. Postoperative complications in the Q-100 group included one myocardial infarction, and one neurological problem. The TMO group had no myocardial infarction and one neurological problem. The membrane oxygenator took nine minutes longer to set up and was $63 more expensive to purchase. Blood trauma during CPB was less with the membrane oxygenator (lower plasma hemoglobin level), but we conclude that both oxygenators performing adequately during clinical use in open heart surgery.
Assuntos
Ponte Cardiopulmonar , Oxigenadores de Membrana , Oxigenadores , Humanos , Estudos ProspectivosRESUMO
The Lillehei-Kaster valve was used in 215 patients over a 7-year period. The aortic valve was replaced in 81 of them. Hospital mortality was 21% (17 patients). Ten patients were lost to follow-up and long-term mortality was 5% (3 patients). The incidence of thromboembolism was 2.6 per 100 patient-years, and actuarial survival was 96% at 5 and 87% at 7 years. Mitral valve replacement was performed in 108 patients. Hospital mortality was 20% (22 patients), 24 patients were lost to follow-up, and long-term mortality was 13% (11 patients). The combined incidence of thromboembolism was 5.0 per 100 patient-years, and actuarial survival was 81% at 5 years and 75% at 7 years. In both groups, the majority of patients improved clinically. Fifteen patients had double-valve replacement, and 11 had coronary revascularization in addition to valve replacement.
Assuntos
Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Criança , Feminino , Seguimentos , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Ohio , Complicações Pós-Operatórias , Tromboembolia/epidemiologia , Tromboembolia/etiologiaRESUMO
Pressures were measured in the heart and great vessels of 52 patients who underwent coronary revascularization. In 25 patients the left ventricle was vented during fibrillation; in the others a vent was not used. Samples for blood gas analysis were obtained twice during fibrillation from the aorta, left atrium, pulmonary artery, and right atrium. Left ventricular venting was found to be effective in keeping mean left heart pressure below 10 mm Hg, although temporary incompetence of the aortic valve or malfunction of the vent occasionally caused higher pressures. Vent use led to air embolism in the aorta in 16% of the patients. In the nonvented patients mean left heart pressures remained between 10 and 20 mm Hg. However, higher values were frequently observed. Blood gas analysis demonstrated that without venting, retrograde pulmonary flow occurred during fibrillation. No abnormality was encountered that could be related to nonventing.
