Effect of an investigational vaccine for preventing Staphylococcus aureus infections after cardiothoracic surgery: a randomized trial.

Importance: Infections due to Staphylococcus aureus are serious complications of cardiothoracic surgery. A novel vaccine candidate (V710) containing the highly conserved S. aureus iron surface determinant B is immunogenic and generally well tolerated in volunteers.

Tremendous bleeding complication after vacuum-assisted sternal closure.

Vacuum-assisted closure (VAC) of complex infected wounds has recently gained popularity among various surgical specialties. The system is based on the application of negative pressure by controlled suction to the wound surface. The effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation are proved.

Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial.

Background: Continuous venovenous haemofiltration (CVVH) in the intensive care setting requires anticoagulation to prevent clotting of the extracorporeal circuit. Several protocols avoiding heparin and using regional citrate anticoagulation have been developed to diminish bleeding risks. However, data from randomized trials comparing citrate anticoagulation with systemic heparinization are very limited.

The impact of intravenous aspirin administration on platelet aspirin resistance after on-pump coronary artery bypass surgery.

Aspirin resistance continues to be a major challenge in patients after coronary artery bypass grafting (CABG). We investigated the impact of intravenous aspirin on platelet function in this clinical setting. Forty-two patients received 100 mg of oral aspirin once daily, beginning on day 1 after the operation.

Case report: fatal hepatic failure after aortic valve replacement and sevoflurane exposure.

Purpose: To report a case of lethal hepatotoxicity possibly caused by sevoflurane.

Clinical Features: A 76-yr-old woman with a history of four previous minor surgical procedures developed acute liver failure after general anesthesia with sevoflurane, sufentanil and propofol for aortic valve replacement. After an uneventful procedure the patient was extubated 4.

Evaluating a new method for maintaining body temperature during OPCAB and robotic procedures.

Background: We evaluated the performance of a new temperature management system (Allon Thermowrap, MTRE, Israel) in maintaining normothermia during OPCAB (Off-Pump Coronary Artery Bypass) procedures and Zeus-robotic IMA (internal mammary artery) takedowns.

Material/methods: One hundred patients were prospectively randomized to either a conventional temperature management method (thick blanket, warm intravenous fluids, operating room temperature 25 degrees C), or the new Allon Thermowrap system (pads with temperature-controlled water circulation placed on the patient's back, legs, and arms). The mean age, body surface area, total operating time, and OR air temperature were similar in both groups.

Advanced sternal closure to prevent dehiscence in obese patients.

Sternal dehiscence is a frequent complication after cardiac surgical procedures. The objective was to evaluate a novel method for advanced sternal closure compared with standard techniques for preventing sternal dehiscence. Our investigation comprised 100 patients with a body mass index above 32.

Relationship between factor XIII activity, fibrinogen, haemostasis screening tests and postoperative bleeding in cardiopulmonary bypass surgery.

We investigated the relationship between factor XIII, fibrinogen, blood coagulation screening tests and postoperative bleeding in 98 patients undergoing cardiopulmonary bypass (CPB) surgery. All patients received aprotinin. Blood samples were collected preoperatively (T1),after termination of CPB (T2),12 h (T3) and 24 h (T4) after surgery to determine FXIII activity, fibrinogen, platelet count, prothrombin time (PT), activated partial thromboplastin time (APTT) and D-dimers (DD).

Cardioprotective anesthesia in patients undergoing coronary surgery: fact or fiction?

The use of volatile anesthetics in patients undergoing coronary artery bypass grafting resulted in a shorter length of stay (LOS) in the intensive care unit, shorter LOS in the hospital, and a decreased need for prolonged intensive care. Volatile anesthetics exert cardioprotective effects by anesthetic preconditioning in patients at risk of myocardial ischemia. Sarcolemmal and mitochondrial ATP-dependent potassium channels are the key for anesthetic preconditioning.

The prophylactic use of the beta-blocker esmolol in combination with phosphodiesterase III inhibitor enoximone in elderly cardiac surgery patients.

We assessed the influence of the prophylactic use of a combination of the IV beta-adrenergic blocker, esmolol, and the phosphodiesterase III inhibitor, enoximone, on postbypass hemodynamic status, inflammation, and endothelial and organ function in a prospective, randomized, placebo-controlled study in 42 patients aged >65 yr undergoing aortocoronary bypass grafting. In 21 patients, esmolol (aim: heart rate <70 bpm) plus enoximone (initial bolus of 0.5 mg/kg followed by a continuous infusion of 2.

Blood-air interface during cardiopulmonary bypass.

The aim of this study was to compare the systemic blood activation with open and closed perfusion management during cardiopulmonary bypass. In 30 patients undergoing coronary artery bypass grafting, we prospectively studied systemic blood activation, blood loss and the need for donor blood. In 15 patients we used an open venous reservoir consisting of a hard shell venous reservoir with an integrated cardiotomy filter.

The influence of allogeneic red blood cell transfusion compared with 100% oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery.

In this study we investigated the effects of allogeneic red blood cell (RBC) transfusion on tissue oxygenation compared with those of 100% oxygen ventilation by using systemic oxygen transport variables and skeletal muscle oxygen tension (PtiO2). Fifty-one volume-resuscitated, mechanically ventilated patients with a nadir hemoglobin concentration in the range from 7.5 to 8.

Levosimendan in patients with cardiogenic shock undergoing surgical revascularization: a case series.

Background: Levosimendan is a new calcium sensitizer, which enhances myocardial contractility while simultaneously having vasodilatory and cardioprotective effects. These properties could be advantageous in patients with myocardial ischemia requiring inotropic support.

Material/methods: 10 patients with acute myocardial ischemia, cardiogenic shock, and/or cardiopulmonary resuscitation undergoing emergency surgical revascularization were treated with levosimendan (bolus 6 microg.

Kidney-specific proteins in elderly patients undergoing cardiac surgery with cardiopulmonary bypass.

Unlabelled: In cardiac surgery, acute renal failure (ARF) is more likely in elderly patients than in younger patients. We assessed whether kidney function is different between elderly and younger cardiac surgery patients by measuring kidney-specific proteins. Forty consecutive patients aged <60 yr and 40 patients aged >70 yr without preoperative kidney dysfunction undergoing elective cardiac surgery with cardiopulmonary bypass (CPB) were included.

Intracardiac left ventricular support in beating heart, multi-vessel revascularization.

Background: Less invasive operation procedures without support of extracorporeal circulation are becoming increasingly important. A basic requirement for good long-term results in such cases is, however, the complete revascularization of the affected coronary vessels. The unsatisfactorily high conversion rate from bypass operations originally planned as off-pump to conventional operations with heart-lung machines, because of the failure to reach the target vessels on the rear wall of the heart through hemodynamic instability led to investigation of the efficiency of a microaxial pump (Impella elect) placed in the left ventricle.

Robotic surgery using Zeus MicroWrist technology: the next generation.

Background: The use of computer-animated surgical instruments for various cardiac operations has been shown to be feasible, but to date, the available information regarding the operative and technical details of these procedures is still inadequate.

Methods: We used the Zeus (Computer Motion Inc., Goleta, Calif, USA) telemanipulation system to perform the internal mammary artery (IMA) takedown in 56 patients, in 12 of whom we used the newest model with MicroWristTM (Computer Motion Inc.

Is kidney function altered by the duration of cardiopulmonary bypass?

Background: Cardiopulmonary bypass (CPB) is considered responsible for kidney damage. By using sensitive markers of kidney damage we assessed whether the length of CPB influences kidney function.

Methods: In a prospective study, 50 consecutive cardiac operation patients with CPB times of less than 70 minutes were compared with 50 consecutive patients showing CPB times of more than 90 minutes.

Bispectral index-guided anesthesia in patients undergoing aortocoronary bypass grafting.

In this prospective, randomized study, we compared hemodynamics, oxygenation, possible intraoperative awareness, and costs in 62 patients undergoing first-time elective coronary artery bypass grafting at 2 different levels of anesthesia. Depth of anesthesia was assessed with bispectral index (BIS). All patients were anesthetized with sufentanil/midazolam.

Topical application of aprotinin in cardiac surgery.

The aim of our study was to compare a systemic and a local aprotinin application in patients during coronary artery bypass graft (CABG) surgery. The advantage of a topical aprotinin application is seen in the fact that this may not lead to systemic side effects. A prospective, randomized study comprising 97 patients was conducted.

Platelet function test HemoSTATUS 2: tool or toy for an optimized management of hemostasis?

Background: Bleeding after open heart surgery is a common but unintended problem, which is unequivocally related to platelet function. The target of our study was to correlate platelet activation levels and postoperative blood loss as well as the predictive power of measurements focusing on postoperative hemostasis.

Materials And Methods: The prospective trial comprised 100 patients (mean age: 64.

Volume therapy with a new hydroxyethyl starch solution in cardiac surgical patients before cardiopulmonary bypass.

Objective: To compare the hemodynamic efficacy of a new hydroxyethyl starch (HES) preparation (130/0.4) with an HES 200/0.5 solution.