The well known correlation between prosthetic valve orifice area and transvalvular pressure drop ... more The well known correlation between prosthetic valve orifice area and transvalvular pressure drop has raised concerns about the presence of significant residual gradients when only a small-sized prosthesis can be implanted, particularly in patients with a large body surface area. The aim of this study was to study the hemodynamic performance of small-size St. Jude Medical aortic prostheses using dobutamine echocardiography. Fifteen patients (14 females, one male, of mean age 67 years) who had undergone aortic valve replacement with size 19 mm St. Jude Medical prostheses at a mean of 19 +/- 8 (SD) months previously were studied. Dobutamine infusion was started at a rate of 5 micrograms/kg/min and increased to 10 and subsequently to 20 micrograms/kg/min at 15-min intervals. Pulsed and continuous-wave Doppler studies were performed at rest and at the end of each stage. Effective orifice area (EOA) and mean gradient across each prosthesis were calculated, and cardiac output (CO) was determined by Doppler measurement of flow in the left ventricular outflow tract. Dobutamine-stress increased heart rate and cardiac output by 57% and 86% respectively (both p < 0.0005), and mean transvalvular gradient increased from 22.0 +/- 4.9 mmHg at rest to 41.9 +/- 9 mmHg at maximum stress (p < 0.0001). Regression modeling analyses demonstrated that maximum stress gradient was independent of all variables except resting gradient (p = 0.0068). Body surface areas had no effect on the changes in cardiac output, effective orifice area or transprosthetic gradient at maximum stress. These data demonstrate that the size 19 mm St. Jude Medical prosthesis exhibits favorable hemodynamic performance. Transvalvular gradients remained within a clinically acceptable range, both at rest and under stress conditions. Moreover, in the patient population studied, overall hemodynamic performance indicates that with St. Jude Medical aortic valves, patient-prosthesis mismatch is unlikely to be a problem of clinical importance.
Interactive cardiovascular and thoracic surgery, 2006
Rapid advances in technology are increasing the repertoire of techniques available for the surgic... more Rapid advances in technology are increasing the repertoire of techniques available for the surgical treatment of atrial fibrillation (AF). These techniques utilize new devices which are normally safe. However, potential problems can arise with a new device as is illustrated in this report. A 58-year-old man underwent a thoracosopic AF ablation utilizing the Flex 10 probe (Guidant, Afix, Fremont, CA). We experienced an important device failure following thoracoscopic microwave AF ablation that has not been reported to date. Although new devices seem to be safe, potential problems often emerge with time, and clinicians pioneering these technologies have an obligation to report these experiences to the wider surgical community.
Interactive cardiovascular and thoracic surgery, 2007
This study demonstrates the efficacy and eligibility of concomitant epicardial microwave AF (MWAF... more This study demonstrates the efficacy and eligibility of concomitant epicardial microwave AF (MWAF) ablation during off-pump arterial revascularisation using the left internal mammary to radial 'Y' graft (OPCABy) in patients with permanent and paroxysmal atrial fibrillation. From June 2004 to December 2005, sixteen consecutive patients were offered MWAF ablation and OPCABy. AF was permanent in 11 cases and paroxysmal in five. The MWAF ablation protocol exploited the use of either the Flex 4 or Flex 10 probe (Afx- Guidant, Santa Clara, CA). Spontaneous cardioversion was used to demonstrate conduction block. Data were collected prospectively. Patients were followed-up in outpatient clinic at 6 weeks, 3 months and 6 months after discharge. Sinus rhythm was seen in 75%, 67% and 71% of patients at conclusion of surgery, and 3 and 6 months postoperatively. Cardioversion to sinus rhythm was seen in 67% of patients with permanent AF and 80% of patients with paroxysmal AF. Spontaneous...
The well known correlation between prosthetic valve orifice area and transvalvular pressure drop ... more The well known correlation between prosthetic valve orifice area and transvalvular pressure drop has raised concerns about the presence of significant residual gradients when only a small-sized prosthesis can be implanted, particularly in patients with a large body surface area. The aim of this study was to study the hemodynamic performance of small-size St. Jude Medical aortic prostheses using dobutamine echocardiography. Fifteen patients (14 females, one male, of mean age 67 years) who had undergone aortic valve replacement with size 19 mm St. Jude Medical prostheses at a mean of 19 +/- 8 (SD) months previously were studied. Dobutamine infusion was started at a rate of 5 micrograms/kg/min and increased to 10 and subsequently to 20 micrograms/kg/min at 15-min intervals. Pulsed and continuous-wave Doppler studies were performed at rest and at the end of each stage. Effective orifice area (EOA) and mean gradient across each prosthesis were calculated, and cardiac output (CO) was dete...
In order to clarify the role of thrombolytic therapy for the treatment of left sided prosthetic v... more In order to clarify the role of thrombolytic therapy for the treatment of left sided prosthetic valve thrombosis, a composite analysis of 158 cases reported in the English literature was undertaken. Complete success of therapy was achieved in 68.4% of patients, and the results were better in patients with aortic compared to mitral valve prostheses (p < 0.01), in those presenting in lower NYHA class (p < 0.01), and with acute rather than chronic symptoms (p < 0.05). A successful outcome was seen more frequently with tilting disc than bileaflet valves (p < 0.001). Overall mortality during therapy was 7%. Cerebral embolic events were observed in 9.5% of patients, and irreversible neurological injury occurred in 4.4%. The rethrombosis rate was 17% and the incidence of late death was 6.3%. Thrombolysis may be a useful therapeutic alternative for left sided prosthetic valve thrombosis in patients with a perceived contraindication to surgery. The risks of systemic clot emboliza...
Annals of the Royal College of Surgeons of England, 1994
Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though... more Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though there have been no published randomised controlled trials to demonstrate the safety of this approach. We present an audit of 555 patients offered laparoscopic cholecystectomy. In all, 54 patients (9.7%) were converted to an open procedure. Peroperative cholangiography (POC) was attempted in 190 cases (34.2%) and achieved in 141 (25.4%). Major complications occurred in 26 cases (4.7%) including 5 (0.9%) deaths, two of whom had major pre-existing morbidity. There was one common bile duct (CBD) injury (0.18%). There were 30 patients (5.4%) found to have CBD stones, 27 of which were cleared at ERCP, and three converted to open exploration. Cholecystectomy by any route is a major operation and we conclude that careful case selection remains imperative. However, morbidity is favourable compared with open cholecystectomy, and comparable with other reports using the laparoscopic technique. Our ...
There is a perceived conflict between the need for service provision and surgical training within... more There is a perceived conflict between the need for service provision and surgical training within the National Health Service (NHS). Trainee surgeons tend to be slower (thereby reducing theatre throughput), and may have more complications (increasing hospital stay and costs). To quantify the effect of training on outcome and costs. Data on 2740 consecutive isolated coronary artery bypass (CABG) operations were analysed retrospectively. Redo and emergency procedures were excluded. The seniority of the operating surgeon was related to operating times, risk stratified outcome, and overall hospital costs. Regional cardiothoracic surgery unit. Postoperative mortality; hospital costs. Consultants, senior trainees, intermediate trainees, and junior trainees performed 1524, 759, 434, and 23 procedures, respectively. Trainees at the three different levels were directly supervised by a consultant in 55%, 95%, and 100% of cases. The unadjusted mortalities were 3.2%, 2.0%, 2.3%, and 4.3%, respe...
Arterio-venous fistulae increase the diameter of their feeding artery. It may be advantageous to ... more Arterio-venous fistulae increase the diameter of their feeding artery. It may be advantageous to increase the diameter of the internal thoracic artery before its use for coronary grafting. A fistula applied directly to the internal thoracic artery may compromise its subsequent use as a coronary graft and is technically difficult and invasive. However, in view of the continuity between the internal thoracic artery and the inferior epigastric artery, it is possible to achieve the same effect by constructing a fistula on the latter. The purpose of this work was to determine, in a cadaveric study, the feasibility of carrying out an arterio-venous fistula on the inferior epigastric artery so as to increase the caliber of the internal thoracic artery before coronary grafting. A morphologic study of the inferior epigastric artery and its vein and their relations as well as the feasibility of such a fistula was carried out on 10 cadavers. The epigastric artery measured 12.35+/-1.2 cm in length. Its diameter decreased from its origin towards it termination from 3.16+/-0.26 cm to 1.76+/-0.18 cm. There was a constant connection between the inferior and superior epigastric arteries. This connection was single in 30% of cases, double in 50% and through an anastomotic plexus of more than two vessels in 20%. The mean number of anastomotic connections was 1.8. The epigastric vein was constant with a diameter of 0.75+/-0.06 mm at its origin and only sufficiently large to carry out a fistula at its termination (2.6+/-0.9 mm). In conclusion, this study indicates that it should be relatively simple to create a fistula between the inferior epigastric artery and either the inferior epigastric vein or the external iliac vein.
... Aoki, Kenzo. Elevated Levels of High-Sensitivity C-Reactive Protein and Serum Amyloid-A Late ... more ... Aoki, Kenzo. Elevated Levels of High-Sensitivity C-Reactive Protein and Serum Amyloid-A Late After Kawasaki Disease: Association Between Inflammation and Late Coronary Sequelae in Kawasaki Disease Circulation . 2005 ...
The Journal of Thoracic and Cardiovascular Surgery, 1996
Dobutamine stress Doppler echocardiography was used to compare the hemodynamic performance of two... more Dobutamine stress Doppler echocardiography was used to compare the hemodynamic performance of two small aortic bileaflet prostheses. Nineteen patients (14 female, mean age 64 years) who had undergone aortic valve replacement with 21 mm bileaflet valve prostheses (St. Jude Medical valve, n = 9, or CarboMedics valve, n = 10) were studied. Dobutamine infusion was started at a rate of 5 micrograms.kg-1.min-1 and increased to 10 and 20 micrograms.kg-1.min-1 at 15-minute intervals. Under maximum stress, heart rate and cardiac output increased by 70% and 120%, respectively, and mean arterial blood pressure decreased by 9%. Pulsed-wave and continuous-wave Doppler studies were performed at rest and at the end of each stage. Velocity ratio, effective orifice area, performance index, and discharge coefficient of the valve were calculated, and peak and mean velocities and pressure drops across the prostheses were measured. Dobutamine infusion produced similar increases in cardiac output in all patients. Effective orifice areas, discharge coefficients, and performance indexes were comparable for the two valve groups both at rest and maximum stress. Transvalvular velocities and pressure drops were also similar in the two valve groups. Transvalvular pressure drops were also comparable in patients with large body surface area. Dobutamine stress echocardiography is useful in the evaluation of the hemodynamic performance of prosthetic heart valves. St. Jude Medical and CarboMedics 21 mm prostheses have equally favorable hemodynamic performances in most patients under conditions of high cardiac output.
The Journal of Thoracic and Cardiovascular Surgery, 1997
Normothermic cardiopulmonary bypass has been proposed as a more physiologic technique than hypoth... more Normothermic cardiopulmonary bypass has been proposed as a more physiologic technique than hypothermic bypass for the maintenance of the body during cardiac surgery. The aims of this study were to investigate the effects of systemic perfusion temperature on clinical outcome after coronary revascularization. Three hundred patients (mean age 60 +/- 9 years, 88% male) were prospectively randomized into three groups: hypothermia (28 degrees C, n = 100), moderate hypothermia (32 degrees C, n = 100), and normothermia (37 degrees C, n = 100). All patients received cold antegrade St. Thomas&amp;amp;#39; Hospital crystalloid cardioplegic solution, and patients in the normothermic group were actively rewarmed during cardiopulmonary bypass (nasopharyngeal temperature 37 degrees C). No differences were found between groups with respect to mortality (1%), intraaortic balloon pump use, perioperative infarction rates, focal neurologic deficits (1%), intubation time, intensive care unit stay, and postoperative hospital stay. Further stepwise regression analysis identified age and intensive care unit stay as important predictors of the variability in postoperative stay (both R2 = 0.114; p &amp;amp;lt; 0.001), whereas perfusion temperature remained a nonsignificant explanator. Normothermic perfusion necessitated larger doses of phenylephrine to maintain arterial pressure above 50 mm Hg during cardiopulmonary bypass (p &amp;amp;lt; 0.0001 vs 28 degrees C, p &amp;amp;lt; 0.01 vs 32 degrees C) but less requirement for electrical defibrillation during reperfusion (p &amp;amp;lt; 0.05 vs 32 degrees C, p &amp;amp;lt; 0.01 vs 28 degrees C). Total chest drainage was not different between groups, but patients undergoing normothermic cardiopulmonary bypass required less transfusion of blood (p &amp;amp;lt; 0.05 vs 28 degrees C and 32 degrees C) and platelets (p &amp;amp;lt; 0.04 vs 32 degrees C, p &amp;amp;lt; 0.001 vs 28 degrees C) in the postoperative period. Cardiopulmonary bypass temperature did not influence early clinical outcome after routine coronary artery bypass operations. Normothermic systemic perfusion was associated with an increased requirement for vasoconstrictors and reduced requirements for electrical defibrillation and transfusion of blood products.
Left ventricular volume reduction has recently been introduced as a surgical treatment for end st... more Left ventricular volume reduction has recently been introduced as a surgical treatment for end stage dilated cardiomyopathy. This operation involves the resection of a slice of viable left ventricular myocardium in order to reduce the wall tension imposed upon the contracting heart chamber. Early results are encouraging, but clinical evaluation on a larger scale is required. In the present article, we describe the indications, surgical principles and results of left ventricular volume reduction surgery with reference to our group&amp;amp;#39;s experience.
The well known correlation between prosthetic valve orifice area and transvalvular pressure drop ... more The well known correlation between prosthetic valve orifice area and transvalvular pressure drop has raised concerns about the presence of significant residual gradients when only a small-sized prosthesis can be implanted, particularly in patients with a large body surface area. The aim of this study was to study the hemodynamic performance of small-size St. Jude Medical aortic prostheses using dobutamine echocardiography. Fifteen patients (14 females, one male, of mean age 67 years) who had undergone aortic valve replacement with size 19 mm St. Jude Medical prostheses at a mean of 19 +/- 8 (SD) months previously were studied. Dobutamine infusion was started at a rate of 5 micrograms/kg/min and increased to 10 and subsequently to 20 micrograms/kg/min at 15-min intervals. Pulsed and continuous-wave Doppler studies were performed at rest and at the end of each stage. Effective orifice area (EOA) and mean gradient across each prosthesis were calculated, and cardiac output (CO) was determined by Doppler measurement of flow in the left ventricular outflow tract. Dobutamine-stress increased heart rate and cardiac output by 57% and 86% respectively (both p &amp;amp;amp;amp;amp;amp;lt; 0.0005), and mean transvalvular gradient increased from 22.0 +/- 4.9 mmHg at rest to 41.9 +/- 9 mmHg at maximum stress (p &amp;amp;amp;amp;amp;amp;lt; 0.0001). Regression modeling analyses demonstrated that maximum stress gradient was independent of all variables except resting gradient (p = 0.0068). Body surface areas had no effect on the changes in cardiac output, effective orifice area or transprosthetic gradient at maximum stress. These data demonstrate that the size 19 mm St. Jude Medical prosthesis exhibits favorable hemodynamic performance. Transvalvular gradients remained within a clinically acceptable range, both at rest and under stress conditions. Moreover, in the patient population studied, overall hemodynamic performance indicates that with St. Jude Medical aortic valves, patient-prosthesis mismatch is unlikely to be a problem of clinical importance.
Interactive cardiovascular and thoracic surgery, 2006
Rapid advances in technology are increasing the repertoire of techniques available for the surgic... more Rapid advances in technology are increasing the repertoire of techniques available for the surgical treatment of atrial fibrillation (AF). These techniques utilize new devices which are normally safe. However, potential problems can arise with a new device as is illustrated in this report. A 58-year-old man underwent a thoracosopic AF ablation utilizing the Flex 10 probe (Guidant, Afix, Fremont, CA). We experienced an important device failure following thoracoscopic microwave AF ablation that has not been reported to date. Although new devices seem to be safe, potential problems often emerge with time, and clinicians pioneering these technologies have an obligation to report these experiences to the wider surgical community.
Interactive cardiovascular and thoracic surgery, 2007
This study demonstrates the efficacy and eligibility of concomitant epicardial microwave AF (MWAF... more This study demonstrates the efficacy and eligibility of concomitant epicardial microwave AF (MWAF) ablation during off-pump arterial revascularisation using the left internal mammary to radial 'Y' graft (OPCABy) in patients with permanent and paroxysmal atrial fibrillation. From June 2004 to December 2005, sixteen consecutive patients were offered MWAF ablation and OPCABy. AF was permanent in 11 cases and paroxysmal in five. The MWAF ablation protocol exploited the use of either the Flex 4 or Flex 10 probe (Afx- Guidant, Santa Clara, CA). Spontaneous cardioversion was used to demonstrate conduction block. Data were collected prospectively. Patients were followed-up in outpatient clinic at 6 weeks, 3 months and 6 months after discharge. Sinus rhythm was seen in 75%, 67% and 71% of patients at conclusion of surgery, and 3 and 6 months postoperatively. Cardioversion to sinus rhythm was seen in 67% of patients with permanent AF and 80% of patients with paroxysmal AF. Spontaneous...
The well known correlation between prosthetic valve orifice area and transvalvular pressure drop ... more The well known correlation between prosthetic valve orifice area and transvalvular pressure drop has raised concerns about the presence of significant residual gradients when only a small-sized prosthesis can be implanted, particularly in patients with a large body surface area. The aim of this study was to study the hemodynamic performance of small-size St. Jude Medical aortic prostheses using dobutamine echocardiography. Fifteen patients (14 females, one male, of mean age 67 years) who had undergone aortic valve replacement with size 19 mm St. Jude Medical prostheses at a mean of 19 +/- 8 (SD) months previously were studied. Dobutamine infusion was started at a rate of 5 micrograms/kg/min and increased to 10 and subsequently to 20 micrograms/kg/min at 15-min intervals. Pulsed and continuous-wave Doppler studies were performed at rest and at the end of each stage. Effective orifice area (EOA) and mean gradient across each prosthesis were calculated, and cardiac output (CO) was dete...
In order to clarify the role of thrombolytic therapy for the treatment of left sided prosthetic v... more In order to clarify the role of thrombolytic therapy for the treatment of left sided prosthetic valve thrombosis, a composite analysis of 158 cases reported in the English literature was undertaken. Complete success of therapy was achieved in 68.4% of patients, and the results were better in patients with aortic compared to mitral valve prostheses (p < 0.01), in those presenting in lower NYHA class (p < 0.01), and with acute rather than chronic symptoms (p < 0.05). A successful outcome was seen more frequently with tilting disc than bileaflet valves (p < 0.001). Overall mortality during therapy was 7%. Cerebral embolic events were observed in 9.5% of patients, and irreversible neurological injury occurred in 4.4%. The rethrombosis rate was 17% and the incidence of late death was 6.3%. Thrombolysis may be a useful therapeutic alternative for left sided prosthetic valve thrombosis in patients with a perceived contraindication to surgery. The risks of systemic clot emboliza...
Annals of the Royal College of Surgeons of England, 1994
Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though... more Laparoscopic techniques have revolutionised the surgical approach to cholecystectomy, even though there have been no published randomised controlled trials to demonstrate the safety of this approach. We present an audit of 555 patients offered laparoscopic cholecystectomy. In all, 54 patients (9.7%) were converted to an open procedure. Peroperative cholangiography (POC) was attempted in 190 cases (34.2%) and achieved in 141 (25.4%). Major complications occurred in 26 cases (4.7%) including 5 (0.9%) deaths, two of whom had major pre-existing morbidity. There was one common bile duct (CBD) injury (0.18%). There were 30 patients (5.4%) found to have CBD stones, 27 of which were cleared at ERCP, and three converted to open exploration. Cholecystectomy by any route is a major operation and we conclude that careful case selection remains imperative. However, morbidity is favourable compared with open cholecystectomy, and comparable with other reports using the laparoscopic technique. Our ...
There is a perceived conflict between the need for service provision and surgical training within... more There is a perceived conflict between the need for service provision and surgical training within the National Health Service (NHS). Trainee surgeons tend to be slower (thereby reducing theatre throughput), and may have more complications (increasing hospital stay and costs). To quantify the effect of training on outcome and costs. Data on 2740 consecutive isolated coronary artery bypass (CABG) operations were analysed retrospectively. Redo and emergency procedures were excluded. The seniority of the operating surgeon was related to operating times, risk stratified outcome, and overall hospital costs. Regional cardiothoracic surgery unit. Postoperative mortality; hospital costs. Consultants, senior trainees, intermediate trainees, and junior trainees performed 1524, 759, 434, and 23 procedures, respectively. Trainees at the three different levels were directly supervised by a consultant in 55%, 95%, and 100% of cases. The unadjusted mortalities were 3.2%, 2.0%, 2.3%, and 4.3%, respe...
Arterio-venous fistulae increase the diameter of their feeding artery. It may be advantageous to ... more Arterio-venous fistulae increase the diameter of their feeding artery. It may be advantageous to increase the diameter of the internal thoracic artery before its use for coronary grafting. A fistula applied directly to the internal thoracic artery may compromise its subsequent use as a coronary graft and is technically difficult and invasive. However, in view of the continuity between the internal thoracic artery and the inferior epigastric artery, it is possible to achieve the same effect by constructing a fistula on the latter. The purpose of this work was to determine, in a cadaveric study, the feasibility of carrying out an arterio-venous fistula on the inferior epigastric artery so as to increase the caliber of the internal thoracic artery before coronary grafting. A morphologic study of the inferior epigastric artery and its vein and their relations as well as the feasibility of such a fistula was carried out on 10 cadavers. The epigastric artery measured 12.35+/-1.2 cm in length. Its diameter decreased from its origin towards it termination from 3.16+/-0.26 cm to 1.76+/-0.18 cm. There was a constant connection between the inferior and superior epigastric arteries. This connection was single in 30% of cases, double in 50% and through an anastomotic plexus of more than two vessels in 20%. The mean number of anastomotic connections was 1.8. The epigastric vein was constant with a diameter of 0.75+/-0.06 mm at its origin and only sufficiently large to carry out a fistula at its termination (2.6+/-0.9 mm). In conclusion, this study indicates that it should be relatively simple to create a fistula between the inferior epigastric artery and either the inferior epigastric vein or the external iliac vein.
... Aoki, Kenzo. Elevated Levels of High-Sensitivity C-Reactive Protein and Serum Amyloid-A Late ... more ... Aoki, Kenzo. Elevated Levels of High-Sensitivity C-Reactive Protein and Serum Amyloid-A Late After Kawasaki Disease: Association Between Inflammation and Late Coronary Sequelae in Kawasaki Disease Circulation . 2005 ...
The Journal of Thoracic and Cardiovascular Surgery, 1996
Dobutamine stress Doppler echocardiography was used to compare the hemodynamic performance of two... more Dobutamine stress Doppler echocardiography was used to compare the hemodynamic performance of two small aortic bileaflet prostheses. Nineteen patients (14 female, mean age 64 years) who had undergone aortic valve replacement with 21 mm bileaflet valve prostheses (St. Jude Medical valve, n = 9, or CarboMedics valve, n = 10) were studied. Dobutamine infusion was started at a rate of 5 micrograms.kg-1.min-1 and increased to 10 and 20 micrograms.kg-1.min-1 at 15-minute intervals. Under maximum stress, heart rate and cardiac output increased by 70% and 120%, respectively, and mean arterial blood pressure decreased by 9%. Pulsed-wave and continuous-wave Doppler studies were performed at rest and at the end of each stage. Velocity ratio, effective orifice area, performance index, and discharge coefficient of the valve were calculated, and peak and mean velocities and pressure drops across the prostheses were measured. Dobutamine infusion produced similar increases in cardiac output in all patients. Effective orifice areas, discharge coefficients, and performance indexes were comparable for the two valve groups both at rest and maximum stress. Transvalvular velocities and pressure drops were also similar in the two valve groups. Transvalvular pressure drops were also comparable in patients with large body surface area. Dobutamine stress echocardiography is useful in the evaluation of the hemodynamic performance of prosthetic heart valves. St. Jude Medical and CarboMedics 21 mm prostheses have equally favorable hemodynamic performances in most patients under conditions of high cardiac output.
The Journal of Thoracic and Cardiovascular Surgery, 1997
Normothermic cardiopulmonary bypass has been proposed as a more physiologic technique than hypoth... more Normothermic cardiopulmonary bypass has been proposed as a more physiologic technique than hypothermic bypass for the maintenance of the body during cardiac surgery. The aims of this study were to investigate the effects of systemic perfusion temperature on clinical outcome after coronary revascularization. Three hundred patients (mean age 60 +/- 9 years, 88% male) were prospectively randomized into three groups: hypothermia (28 degrees C, n = 100), moderate hypothermia (32 degrees C, n = 100), and normothermia (37 degrees C, n = 100). All patients received cold antegrade St. Thomas&amp;amp;#39; Hospital crystalloid cardioplegic solution, and patients in the normothermic group were actively rewarmed during cardiopulmonary bypass (nasopharyngeal temperature 37 degrees C). No differences were found between groups with respect to mortality (1%), intraaortic balloon pump use, perioperative infarction rates, focal neurologic deficits (1%), intubation time, intensive care unit stay, and postoperative hospital stay. Further stepwise regression analysis identified age and intensive care unit stay as important predictors of the variability in postoperative stay (both R2 = 0.114; p &amp;amp;lt; 0.001), whereas perfusion temperature remained a nonsignificant explanator. Normothermic perfusion necessitated larger doses of phenylephrine to maintain arterial pressure above 50 mm Hg during cardiopulmonary bypass (p &amp;amp;lt; 0.0001 vs 28 degrees C, p &amp;amp;lt; 0.01 vs 32 degrees C) but less requirement for electrical defibrillation during reperfusion (p &amp;amp;lt; 0.05 vs 32 degrees C, p &amp;amp;lt; 0.01 vs 28 degrees C). Total chest drainage was not different between groups, but patients undergoing normothermic cardiopulmonary bypass required less transfusion of blood (p &amp;amp;lt; 0.05 vs 28 degrees C and 32 degrees C) and platelets (p &amp;amp;lt; 0.04 vs 32 degrees C, p &amp;amp;lt; 0.001 vs 28 degrees C) in the postoperative period. Cardiopulmonary bypass temperature did not influence early clinical outcome after routine coronary artery bypass operations. Normothermic systemic perfusion was associated with an increased requirement for vasoconstrictors and reduced requirements for electrical defibrillation and transfusion of blood products.
Left ventricular volume reduction has recently been introduced as a surgical treatment for end st... more Left ventricular volume reduction has recently been introduced as a surgical treatment for end stage dilated cardiomyopathy. This operation involves the resection of a slice of viable left ventricular myocardium in order to reduce the wall tension imposed upon the contracting heart chamber. Early results are encouraging, but clinical evaluation on a larger scale is required. In the present article, we describe the indications, surgical principles and results of left ventricular volume reduction surgery with reference to our group&amp;amp;#39;s experience.
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