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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The management of patients with coexisting severe carotid and coronary artery disease continues to be controversial. To evaluate the actual risks we have reviewed our experience of 92 patients that underwent simultaneous cardiac surgery and carotid thrombendarterectomy (TEA) over a 10 year period. The mean age was 65 +/- 7 year (41-80), 75% were men. There were 11 REDO cardiac procedures. There were 15 symptomatic and 77 asymptomatic carotid artery stenosis, including 21 with bilateral carotid disease. Mean preop.LVEF was 57.4% (15-80%). Carotid TEA was performed under hypothermia (26 degrees C), preferably with beating heart after an equilibration period of 10 min. The overall mortality was 5.4% (5 patients). 4 of the deaths were reoperative cardiac surgery. Non-fatal myocardial infarction occurred in 1 patient. Postop. neurological complications were diagnosed in 7 patients (8%), 3 transient and 4 permanent neurological deficits occurred. 33 patients had no post-operative complications at all and 25 patients had as only complication, transient arrhythmia. Follow-up revealed a 5-year survival rate of 83% and a cardiac event-free survival of 70%, without neurological events. We therefore conclude that simultaneous carotid TEA and cardiac surgery can be performed using controlled hypothermic cardiopulmonary bypass (26 degrees C), in experienced hands, with an acceptable mortality (5.4%) and low morbidity. Carotid TEA combined with two or more cardiac procedures has the highest mortality and morbidity and should be avoided.
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PMID:[Should heart surgery and thromboendarterectomy of the carotid artery be done simultaneously?]. 865 69

There has been increasing interest in the use of retrograde coronary sinus perfusion for delivery of cardioplegic solution during myocardial revascularization. Despite evidence of improved cardiac protection, it is unclear if a combined antegrade/retrograde approach to myocardial preservation offers significant clinical benefits. One hundred twenty patients undergoing elective 1st-time coronary bypass surgery for 3-or-more-vessel disease received aortic root, antegrade cold blood cardioplegia (Group I, n=52) or combined antegrade/retrograde cardioplegia via coronary sinus cannulation (Group II, n=68). All preoperative variables were similar, including age, severity of coronary artery disease, functional status, and ejection fraction. Intraoperative and postoperative variables, including the degree of hypothermia, temperature of infusion solution, number of bypass grafts, defibrillation attempts and spontaneous return to sinus rhythm, the use of intraaortic balloon pump counterpulsation, and inotropic support during weaning from cardiopulmonary bypass, were not statistically different. Cardioplegia infusion time was longer in Group II than in Group I (2.5 +/- 0.8 vs 1.7 +/- 0.7 min, p < 0.05). The postoperative cardia output, electrocardiographic and cardiac enzyme evidence of ischemia, the need for temporary pacing, and 30-day morbidity were similar for both groups. The data indicate that in this non-risk-stratified group of patients, the route of cardioplegia administration is not a determinant of clinical outcome.
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PMID:Comparison of antegrade with antegrade/retrograde cold blood cardioplegia for myocardial revascularization. 868 Feb 85

The introduction of minimally invasive coronary artery bypass surgery has expanded the technical armementarium for operative treatment of coronary artery disease. Minimal access surgery using partial sternotomy or anterior intercostal minimal thoracotomy can be combined with videoscopic techniques or port-access-methods. Either atrio-aortal cannulation, femoro-femoral or jugular-femoral connections to the pump are possible for extracorporal circulation (ECC). Even endoluminar occlusion of the aorta and application of cardioplegia into the aortic root can be considered and applied. Extracorporal circulation has developed into a safe standardized method. As far as pathophysiology is concerned, the decision to use ECC or not is of much more importance than the grade of invasiveness. Fundamentally we therefore need to distinguish between minimally invasive methods with and without ECC. Video-assisted coronary surgery in hearts under hypothermia and fibrillation with ECC is also recommended occasionally. Minimally invasive coronary artery procedures on beating hearts without ECC have to be done in a stabilized and bloodless operative field to allow the construction of high standard anastomoses between bypass grafts and coronary arteries. In practice, silicon occluders, epicardial and myocardial suture occlusion and fixation, mechanical stabilization devices, and pharmacologic induction of bradycardia are used. In principle a skilled surgeon should be familiar with all these methods to select the most suitable solution for the special clinical problem. A final judgement about each method is not possible up to now. High patients numbers have to be recruited in the groups and subgroups due to low mortality (1%) and morbidity (5%), otherwise statistical significance of the results cannot be gained.
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PMID:[Changes in heart surgical strategies: a word of caution]. 1035 68

The aim of the study was to evaluate the influence of changes of chosen immunological parameters on postoperative course patients after cardiopulmonary bypass operation. Complement components C3, C4 and immunoglobulins IgA, IgG, IgM were taken into account. The group consisted of 70 patients, 51 men at mean age 52.6 +/- 10.8 years and 19 women at mean age 50.7 +/- 11.0 years. All patients were operated in moderate hypothermia 26-32 degrees C with use of crystalloid cardioplegia. We used membrane oxygenators: Safe II (Polystan), Monolyth (Sorin), Maxima (Medtronic) and Bentley (Baxter). In 36 patients with multivessel coronary artery disease the internal thoracic artery and saphena vein grafts were performed. 27 patients underwent the valve prosthesis implantation procedure and 7 correction of the congenital heart dis-ease. The mean extracorporeal perfusion time was 127.5 +/- 51.0 min. The mean aortic cross-clamping time was 65.6 +/- 26.9 min. 6 blood samples were taken in the time periods called from 0 to 5: 0--before the operation, 1--right after the operation, 2--1 day after the operation, 3--3 days after the operation, 4--7 days after the operation, 5--14 days after the operation. All the immunological parameters were measured at the Technicon RA-1000 System device using plasma antibody serum of Behring Company. We compared two groups: 1) 21 patients extubated at operation day with 42 patients extubated at 1-th postoperative day, 2) 38 patients with postoperative organ failure with 32 patients without organ complications. The intubation time was shorter in patients with higher levels of C3 (to 7-th day) and C4 (at 1-th postoperative day). The postoperative organ failure were more frequently in patients with lower postoperative C3 (to 3-th day) and with lower C4 at 1-th postoperative day. The postoperative changes of immunoglobulins IgA, IgG, IgM were similar in patients with complicated and uncomplicated postoperative course.
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PMID:[Changes of selected immunological parameters after cardiopulmonary bypass in postop period]. 1048 43

Alkaptonuria is a rare disease of phenylalanine, aromatic amino acids, and tyrosine metabolism. Because of a genetic deficiency of the enzyme homogentisic acid oxidase, an accumulation of homogentisic acid causes ochronotic pigment deposition. The most common clinical manifestations are arthropathy, urinary calculi and discoloration, cutaneous and cartilaginous pigmentation, and cardiac valvular disease. Arthropathy and aortic stenosis are the most debilitating manifestations of the disease. A case of alkaptonuric aortic stenosis is described. A 75-year-old woman with a history of alkaptonuria presented in the emergency department with complaints of progressive dyspnea. Upon examination, the patient was hypertensive, tachypneic, and tachycardic with premature ventricular contractions. She had pitting edema of the lower extremities and complaints of generalized weakness. Chest x-rays revealed congestive heart failure and pulmonary edema. Diuretics were administered, and a continuous nitroglycerin infusion was initiated in the emergency department. The patient was admitted for further evaluation. The patient's respiratory status continued to decline. She was intubated endotracheally 1 day after admission. Subsequent cardiac evaluation revealed an ejection fraction of 35%, severe aortic stenosis, mild coronary artery disease, ischemic cardiomyopathy, and anteroapical akinesis. A dobutamine infusion was instituted for persistent hypotension, and renal dose dopamine was initiated for oliguric renal failure. The patient underwent an emergency operation for an aortic valve replacement with a Dacron patch 10 days after admission. Cardiopulmonary bypass and mild hypothermia were used during the procedure. The patient's hemodynamic status remained tenuous throughout the procedure. Although the first attempt to wean off cardiopulmonary bypass failed, the second attempt was successful with the aid of an intra-aortic balloon pump, inotropic support, and atrioventricular pacing. These measures were maintained during transport to the surgical intensive care unit. In the intensive care unit, the patient did not have an audible blood pressure or a palpable pulse without the support of the intra-aortic balloon pump and atrioventricular pacing. Coarse atrial fibrillation was the underlying electrocardiogram rhythm in the absence of atrioventricular pacing. Sodium bicarbonate was given without improvement. After discussion with the family, all life support measures were discontinued. The patient died 10 minutes after her arrival in the intensive care unit. Alkaptonuria's pathogenesis is manifested as both local and systemic in nature. Collagen vascular diseases share a similar pattern of multisystem involvement. Despite the negative outcome for the patient described, valuable insight can be obtained by studying this case and noting the anesthetic considerations specific to collagen vascular diseases in general.
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PMID:Alkaptonuric aortic stenosis: a case report. 1048 88

The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease still remains controversial. In this report we present a case of a 72-year-old female patient admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe bilateral carotid artery stenosis were diagnosed. A combined, simultaneous surgical procedure was performed. After total circulatory by-pass with a membrane oxygenator, the patient's body temperature was lowered to 32 degrees C. During the cool-down period, three proximal anastomoses of segments of autologous saphenous veins were performed in the ascending aorta. Immediately afterwards, bilateral carotid endarterectomy was performed, followed by three distal anastomoses to coronary arteries. The patient showed a satisfactory post-operative outcome. It was concluded that the combination of moderate hypothermia, hemodilution with appropriate hemodynamic control, as used in this patient, was an effective method of cerebral protection. The simultaneous approach of carotid endarterectomy and coronary artery by-pass surgery should be seen as a safe option for the treatment of this type of patient.
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PMID:Bilateral carotid endarterectomy combined with myocardial revascularization during the same surgical act. 1096 88

The objective of this study was to define the perioperative risk of simultaneous operations in patients with abdominal aortic aneurysm (AAA) associated with coronary artery disease (CAD). The hospital data of 30 patients with coexistent severe symptomatic AAA and significant CAD, who underwent one stage surgery of the abdominal aorta and the coronary arteries was retrospectively analysed. Most of the pts.--28 were male and only 2 female. The average age consisted 57.7 years. Infrarenal AAA (diameter over 5 cm) was presented in 25 patients and suprarenal extension was in presented in 5 pts, while all patients with coexisting CAD had three vessels disease and significant impairment of left ventricular function (23 pts with ejection fraction (EF) < 50% and 10 pts < 30% EF). The resections of AAA in pts. undergoing simultaneous coronary artery procedure were performed on cardiopulmonary bypass (CPB) and moderate hypothermia. There were 2 early postoperative deaths (6.66%) and 5 major nonfatal postoperative complications (16.6%). Our experience with simultaneous surgery of coexistent huge AAA and CAD demonstrated that: a) Combined procedure can be performed safely in patients with significant AAA and CAD. b) The overall early operative mortality and morbidity after combined surgery compare favourably with the results after CABG of patients with impaired left ventricular function. c) Simultaneous operation seems to be more favourable in patients with coexistent AAA and CAD regarding the high risk of aneurysmal rupture, saving them also the potential morbidity and eventually fatal complications associated with the second procedure. d) Even the management of suprarenal and huge infrarenal AAA can be carried out easier and with less risk of complications under the protection of CPB.
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PMID:[Combined surgical treatment of patients with huge aortic abdominal aneurysms associated with coronary artery lesions]. 1119 72

Plasma levels of ANP (pg/ml; radioimmunoassay) as a parameter for postischemic dysfunction and levels of Troponin T (TnT) (ng/ml; ELISA test) as a parameter for postischemic cellular damage were determined in 15 patients with coronary artery disease (CAD) (mean age: 58 +/- 6.1 years; 13 m, 2 w; with no history of myocardial infarction and no signs for congestive heart failure) prior to, during and after extracorporal circulation (ECC). Under standardized conditions during the ECC basic parameters concerning the cardial hemodynamic (heart rate (HR); systolic (RRsys, mmHg), diastolic pressure (RR dia, mmHg) central venous pressure (CVP, mmHg); left atrial pressure (LAP, mmHg); left ventricular enddiastolic pressure (LVEDP, mmHg)) and ECG monitoring blood samples were performed: 1) prior to operation (op); 2) prior to CPB; 3) 1 h CPB; 4) 5 min after CPB; 5) 1 h after CPB; 6) 6 h postoperative (postop); 7) 24 h postop; 8) 48 h postop; 9) 10 days postop. Also the left atrial diameter (LAD, mm) and the left ventricular enddiastolic diameter at Q (LVEDD, mm) pre- and postop were documented with m-mode echocardiography (Echo) and ejection fraction (EF, %) was calculated. The bypass operations were performed with intermittent aortic cross-clamping with open venae cavae (CVP: 0-5 mmHg) and moderate hypothermia. For the determination of ANP levels and TnT levels in arterial and venous blood, a double-antibody (AB) radioimmunoassay and an ELISA test were used. Concerning the patients with CAD there was a maximal increase of ANP from preoperative 90 +/- 10 (M +/- SEM) pg/ml (p < 0.05) up to intraoperative 380 +/- 38 pg/ml. Ten days postop, the ANP level was with 262 +/- 33 pg/ml still increased threefold in comparison to the preoperative level. TnT showed an increase from preoperative 0.02 +/- 0.01 ng/ml up to intraoperative 3.44 +/- 0.47 ng/ml. Ten days postop the TnT concentration was at the preoperative level with 0.13 +/- 0.11 ng/ml. Five minutes after bypass up to 48 h postop, ANP and TnT levels were correlated (p < 0.05, r = 3.4). There was an increase of the LAD from preoperative 42.2 +/- 1.1 mm up to 46.8 +/- 1.2 mm (p < 0.05) 10 days postop as determined by m-mode echo. LVEDD and EF changed from preoperative 51.1 +/- 0.9 mm and 73 +/- 2% to 54.5 +/- 1.2 mm and 65 +/- 4% 10 days postop. The significant increase of TnT (172-fold) indicates the cellular, myocardial injury, caused by the operation without signs in ECG recordings and no signs of congestive heart failure. The significantly increased ANP level up to the 10th day postop indicate sa very sensitive prolonged, postischemic dysfunction, which is not compensated 10 days postop.
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PMID:[Atrial natriuretic peptide as an indicator of mild postoperative cardiac dysfunction after uncomplicated bypass surgery]. 1120 Oct 29

A 48-year-old male patient having none of the known risk factors for atherosclerosis underwent coronary artery bypass graft (CABG) surgery because of double-vessel coronary artery disease. During the operation, the aorta, both internal thoracic arteries (L/R-ITA), and the femoral artery were sclerotic, and CABG was performed using only saphenous vein grafts. A diagnosis of tertiary syphilis had been confirmed by either microscopic or serologic tests. There were different degrees of sclerosis in different arteries of different sizes. The presence of coronary artery disease with no known atherosclerotic risk factors should include preoperative testing for connective tissue disorders, chronic inflammatory disease, and cold hemagglutinins, because of the possible use of obligatory deep hypothermia or total circulatory arrest due to a diseased ascending aorta.
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PMID:Accelerated atherosclerosis in tertiary syphilis and successful treatment with saphenous vein grafting--a case report. 1151 94

Perioperative cardiac morbidity is one of the main challenges to the anaesthesiologist. Because of demographic changes and the increased prevalence of coronary artery disease (CAD) in elderly patients, the number of those at risk is increasing. Special attention has to be paid to patients bearing an increased risk where CAD has not been proven preoperatively because they represent the majority. The use of the "Revised Cardiac Risk Index", which includes patient-related as well as surgery-related risk, is recommended as its predictive value is validated to be very high. Additional preoperative testing is indicated only in those patients at intermediate risk where functional status is poor or unclear. In those with clearly high risk, possibility and urgency of an intervention related to their cardiac disease must be weighed against urgency and invasiveness of planned non-cardiac surgery. Regarding prophylactic perioperative therapy, only beta-blockers can be recommended on a sufficient basis of clinical data. This treatment is of special value in patients with poor functional status and those undergoing vascular surgery. Postoperative continuation of beta blockade for five to seven days is essential to its success. The usefulness of alpha-2-blockers is not equally well-proven so far. Prevention of perioperative hypothermia can reduce cardiac risk. In addition, there is increasing evidence that thoracic epidural anaesthesia decreases cardiovascular morbidity and mortality.
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PMID:[The cardiac risk patient in anesthesia]. 1159 68


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