Abstract:
:Sixty consecutive patients undergoing elective open-heart surgery were prospectively enrolled in a study to compare the efficacy of 3 different antifibrinolytic drugs to reduce postoperative bleeding and to reduce homologous blood requirements in combination with blood-saving techniques and restrictive indications for blood transfusion. The patients were randomized to 1 of 4 intraoperative treatment regimens: 1) control (no antifibrinolytic therapy); 2) epsilon-aminocaproic acid (10 g IV at induction of anesthesia, followed by infusion of 2 g/h for 5 hours); 3) tranexamic acid (10 mg/kg IV within 30 minutes after induction of anesthesia, followed by infusion of 1 mg/kg per hour for 10 hours); or 4) high-dose aprotinin (2 million KIU IV at induction of anesthesia and 2 million KIU added to the extracorporeal circuit, followed by infusion of 500 thousand KIU/h during surgery). Hemoconcentration and reinfusion of blood drained from the operative field and the extracorporeal circuit after operation were used in all patients. Indications for blood transfusion were hypotension, tachycardia, or both, with hemoglobin values < 8.5 g/dL; or severe anemia with hemoglobin values < 7 g/dL. Compared with the blood loss in the control group, patients receiving aprotinin and epsilon-aminocaproic acid showed significantly less postoperative blood loss at 1 hour (control, 128 +/- 94 mL; aprotinin, 54 +/- 47 mL, p = 0.01; and epsilon-aminocaproic acid, 69 +/- 35 mL, p = 0.03); this trend continued at 24 hours after operation (control, 724 +/- 280 mL; aprotinin, 344 +/- 106 mL, p < 0.0001; and epsilon-aminocaproic acid, 509 +/- 148 mL, p = 0.01). Aprotinin was significantly more efficient than epsilon-aminocaproic acid (p=0.002). Tranexamic acid did not have a statistically significant effect on blood loss. Homologous blood requirements were not significantly different among the groups; postoperative hematologic values and coagulation times were also comparable. Despite the efficacy of aprotinin and epsilon-aminocaproic acid shown in the present study, the blood requirements were not significantly different from those that are found when transfusions are restricted, autotransfusions are used, and blood from the operative field and extracorporeal circuit is concentrated and reinfused. Therefore, intraoperative antifibrinolysis may not be indicated in routine cardiac surgery when other blood-saving techniques are adopted.
journal_name
Tex Heart Inst Jjournal_title
Texas Heart Institute journalauthors
Penta de Peppo A,Pierri MD,Scafuri A,De Paulis R,Colantuono G,Caprara E,Tomai F,Chiariello Lsubject
Has Abstractpub_date
1995-01-01 00:00:00pages
231-6issue
3eissn
0730-2347issn
1526-6702journal_volume
22pub_type
临床试验,杂志文章,随机对照试验abstract::Acquired long QT syndrome is typically caused by medications, electrolyte disturbances, bradycardia, or catastrophic central nervous system events. We report a case of myocardial infarction-related acquired long QT syndrome in a 58-year-old woman that had no clear cause and progressed to torsades de pointes requiring ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-18-6872
更新日期:2020-04-01 00:00:00
abstract::Direct cannulation of both venae cavae (bicaval venous cannulation) is the gold standard for right atrial isolation in intracavitary surgery, but there has been no consensus about an alternative site. Therefore, we studied an alternative method for bicaval venous drainage in which the left brachiocephalic vein (LBCV) ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-14-4983
更新日期:2016-04-01 00:00:00
abstract::Because of physiologic R-R interval variability and arrhythmia, frame-mode acquisition of gated images may produce erroneous left ventricular volume curves, particularly in the diastolic filling phase. Eighteen patients in sinus rhythm underwent gated imaging in which both frame-mode and list-mode acquisitions were us...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1984-09-01 00:00:00
abstract::During an 11-year period ending January 1, 1985, 352 patients had insertions of an intraaortic balloon pump (IABP) as an adjunct to medical or surgical therapy. Group I, 175 patients, could not be weaned from cardiopulmonary bypass and required intraaortic balloon pump (IABP). Thirty-nine patients (22%) died in the op...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1986-03-01 00:00:00
abstract::During the management of acute myocardial infarction, we observed that clinical and electrocardiographic indications of myocardial ischemia worsened upon nitroglycerin infusion and were promptly relieved upon streptokinase infusion. Subsequent coronary angiography revealed diffuse ectasia with no significant stenosis....
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1998-01-01 00:00:00
abstract::We describe the case of a 48-year-old woman who required emergency coronary artery bypass grafting because of extensive dissection, cardiogenic shock, and ventricular fibrillation after failed percutaneous transluminal coronary angioplasty for stenosis of a proximal left anterior descending coronary artery. Despite ma...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
abstract::Glucose-6-phosphate dehydrogenase (G6PD) protects erythrocytes from oxidative stress and hemolysis; G6PD deficiency is the most prevalent enzymopathy. The United States military routinely performs tests to prevent exposing G6PD-deficient personnel to antimalarial drugs that might cause life-threatening hemolytic react...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章,多中心研究
doi:10.14503/THIJ-16-6052
更新日期:2018-06-01 00:00:00
abstract::The aim of the study was to investigate, in adult patients after successful repair of aortic coarctation, potential relationships between B-type natriuretic peptide levels and exercise capacity and the following factors: arterial hypertension, residual stenosis of the ascending aorta, and age at the time of surgery. T...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2007-01-01 00:00:00
abstract::Paleopathology, the study of disease in ancient remains, adds the dimension of time to our study of health and disease. The oldest preserved heart is from a mummified rabbit of the Pleistocene epoch, over 20,000 years old. Cardiovascular disease has been identified in human mummies from Alaska and Egypt, covering a ti...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-14-4407
更新日期:2016-02-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 临床试验,杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract::The patient with a patent, infected vascular graft presents a dilemma to the surgeon, who must decide whether revascularization is necessary in addition to removal of the infected graft. When a graft infection points superficially or requires drainage, the graft may be well enough exposed to provide easy access. A tec...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1982-06-01 00:00:00
abstract::The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome o...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2004-01-01 00:00:00
abstract::Inferior vena cava filters are commonly used to prevent pulmonary embolism in patients who manifest deep vein thrombosis and recurrent pulmonary embolism despite anticoagulation, or in patients with contraindications to anticoagulation. We report the case of a 69-year-old man with a structurally normal heart who exper...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2013-01-01 00:00:00
abstract::Surgically created arteriovenous fistulae (AVF) for hemodialysis can contribute to hemodynamic changes. We describe the cases of 2 male patients in whom new right ventricular enlargement developed after an AVF was created for hemodialysis. Patient 1 sustained high-output heart failure solely attributable to the AVF. A...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-15-5353
更新日期:2016-08-01 00:00:00
abstract::Apical akinesis and dilation in the absence of obstructive coronary artery disease is a typical feature of stress-induced (takotsubo) cardiomyopathy, whereas apical hypertrophy is seen in apical-variant hypertrophic cardiomyopathy. We report the cases of 2 patients who presented with takotsubo cardiomyopathy and were ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-13-3191
更新日期:2014-04-01 00:00:00
abstract::We report a modified technique for advancing a catheter or sheath into the right common carotid artery when the aortic arch anatomy is unfavorable.A standard 0.035-inch guidewire is passed into the right subclavian artery, and a diagnostic catheter is threaded over it, deep into the right axillary and brachial artery....
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2008-01-01 00:00:00
abstract::Doxorubicin, an anthracycline antibiotic commonly used as a chemotherapeutic agent for breast cancer, is well known to cause cardiotoxicity. We report the case of an active, otherwise healthy 57-year-old breast cancer survivor who, 17 years after chemotherapy, presented with symptoms of overt heart failure. She had no...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2012-01-01 00:00:00
abstract::The glutaraldehyde-preserved stented porcine xenograft valve has been durable in adult patients with a low incidence of valve-related complications. In children, however, early degeneration and calcification of this valve is now being reported. The etiology of the early degeneration is still unclear but may be related...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1982-03-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-16-6017
更新日期:2017-12-19 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2006-01-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-13-3314
更新日期:2014-10-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
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更新日期:2017-04-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1994-01-01 00:00:00
abstract::Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm cel...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:10.14503/THIJ-16-5802
更新日期:2017-02-01 00:00:00
abstract::Approximately 20% to 30% of patients who undergo coronary arteriography for the evaluation of chest pain are found to have normal coronary arteries. These patients have a survival rate comparable to that of the normal population, yet they continue to complain of symptoms on extended follow-up, and about half of this g...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章,评审
doi:
更新日期:1993-01-01 00:00:00
abstract::We describe a technique for transapical cannulation in cases of acute aortic dissection. This method entails aortic cannulation via the apex of the left ventricle and the aortic valve. When this technique is used, retrograde perfusion prevents such fatal complications as malperfusion or cerebral embolism that can occu...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:2001-01-01 00:00:00
abstract::From January of 1984 through December of 1990, we implanted 739 Pop De Popa wild boar aortic valves in 626 patients, in all cardiac valvular positions. Of these patients, 562 received only the Pop De Popa xenobioprostheses, which numbered 620 valves. Only patients with contraindications for bioprosthetic valves (such ...
journal_title:Texas Heart Institute journal
pub_type: 杂志文章
doi:
更新日期:1992-01-01 00:00:00
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journal_title:Texas Heart Institute journal
pub_type: 杂志文章,评审
doi:
更新日期:1999-01-01 00:00:00