bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Metabolic Responses to Deep Hypothermic Total Circulatory Arrest and Retrograde Cerebral Perfusion in an Experimental Model
Authors: Katircioglu S. Fehmi , Saritas Zülfikar , Kügüker Seref , Ulus A. Tulga , Tütün Ufuk , Aksöyek Aysen , Koç Bahattin , Ayaz Selime 
Published: September 2022

An experimental study was designed to search the effectiveness of retrograde cerebral perfusion which is presently used as cerebral protection method for the surgery of arcus aorta. Twelve dogs were subjected to the study. Six of them were remained in total circulatory arrest at 20 °C for 60 min. Retrograde cerebral perfusion was done again at 20 °C for 1 h for the other six dogs. Tumor necrosis factor (TNF). P-selectin, Intracelluler Adhesion Molecule (ICAM), Creatine Phosphokinase (CPK-BB) and tissue Adenosine triphosphate (ATP) levels were measured, before the cardiopulmonary bypass at 37 °C and during perfusion period at 5, 60 min and 4 h. Tissue ATP level for retrograde cerebral perfusion group was 3.99±0.7 mcmol/g tissue and 2.8610.1 mcmol/g tissue for total circulatory arrest group at fourth hour (p<0.05). TNF level was significantly higher in total circulatory arrest group than retrograde cerebral perfusion group (p<0.05). The samples taken at fourth hour of reperfusion showed the TNF level was, 162.55±13.1 pcg/ml for total circulatory arrest group and this value was 12.5±3.4 pcg/ml for retrograde cerebral perfusion group. ICAM (Intracelluler Adhesion Molecule) level was higher in total circulatory arrest group (18.751±3.6 ng/ml) when compared to retrograde cerebral perfusion group (8.75±1.8 ng/ml) (p<0.05). All parameters showed that retrograde cerebral perfusion preserved the brain functions better comparing with total circulatory arrest. The time necessary for aortic surgery may be provided by the retrograde cerebral perfusion technique.
Dyeless Vascular Surgery
Authors: Hingorani Anil , Ascher Enrico 
Published: September 2022

Purpose The morbidity associated with contrast-based diagnostics performed for preoperative evaluation prior to vascular intervention ranges from 1 to 21%. These complications range from minor hematomas to death. However, these exams are commonly felt to be a necessary step to completely evaluate the arterial tree before intervention is undertaken. Since this has varied from our experience, we reviewed our experience with repair of abdominal aortic aneurysms (AAAs), carotid endartectomy (CEA). and lower extremity revascularization performed without preoperative contrast studies. Materials and methods During the last 10 years, we have performed 184 elective AAA repairs with abdominal-pelvis CAT scan without intravenous contrast as a preoperative study. During this same period of time. 903 CEAs were performed in 810 patients based solely on duplex ultrasonography or in combination with magnetic resonance angiography in cases where duplex ultrasonography was inconclusive (53 cases). Finally, over the last 30 months, we have performed 485 revascularizations in the lower extremity based solely on duplex ultrasonography mapping. Direct visualization of all major arteries from the distal aorta to the pedal vessels was performed using duplex imaging. Both the carotid duplex imaging and lower extremity duplex imaging were confirmed to have greater than 95 % positive predictive value during an initial phase of 50 cases confirmed with MRA and contrast angiography respectively. Results All cases of venous anomalies such as retrocaval left renal vein or left sided inferior vena cava in AAA patients were accurately identified and confirmed by intraoperative findings. No cases of horseshoe kidney were identified. Despite the presence of diminished femoral pulses in six patients, aortic reconstructions were performed with only duplex imaging. The 30 day mortality of AAA patients was 5% for elective repairs, in addition, no gross differences were appreciated with intraoperative findings of CEA as compared to preoperative duplex findings. However, in 5 cases CEA could not be performed due to extension of the lesion well above the available surgical exposure. The 30 day mortality of the CEA patients was 0.7% and the incidence of postoperative stroke or transient ischemic attack was 0.7%. Finally, in two early cases of lower extremity revascularization, the distal anastomosis was placed proximal to a lesion. This was appreciated during the procedure and corrected with a jump graft in each case. Conclusions These data suggest that AAA repair, CEA, and lower extremity revascularization can be performed without contrast based preoperative studies and without compromise to evaluation of disease, patient safety or patency of bypass grafts.
The Chemically Treated Bovine Ureter—Clinical Performance of a Novel Biological Vascular Prosthesis
Authors: Field P. L. 
Published: September 2022

Aim This paper describes the rationale, development and clinical performance of a novel small-diameter vascular prosthesis of non-vascular animal tissue origin. Method Durable conduits suitable for coronary and peripheral arterial reconstruction are prepared for the first time from non-vascular animal tissue. Australian bovine ureters from young steers from protected herds are processed to form strong, bloodflow-compatible and non-immunogenic biologic grafts (‘Flonova’ R, Bionova International Pty Ltd, Melbourne). Fifty-six patients lacking suitable autogenous veins received 62 prostheses (32 bypasses were implanted above knee and 30 below knee). Determination of patency and function included Doppler ultrasound, duplex scanning and angiography. Findings The primary patency rate at 1, 2 and 5 years, respectively was 67, 59 and 52% and the secondary patency for the same time frames was 88, 73 and 61%. There were no occlusions as a result of intimal hyperplasia. Dilatation of the wall was diagnosed in one prosthesis at 3.5 years, and one at 7 years, and a false aneurysm of unknown aetiology occurred in another at 3 months. There were no primary graft infections. Conclusion This evaluation shows the chemically treated bovine ureter (CTBU) is a viable medium-term alternative to the currently available artificial vascular prostheses for peripheral revascularisation.
The Effect of Inhibition of Renin-Angiotensin System by Valsartan during Hypovolemic Shock and Low Flow Sigmoideal Ischaemia in Pigs
Authors: Yilmaz E. N. , Vahl A. C. , van Rij G. L. , Vink G. Q. M. , Brom H. L. F. , Rauwerda J. A. 
Published: September 2022

The aim of this experiment was to study the effect of Renin-Angiotensin System (RAS) blockade by means of valsartan on the colonic and systemic circulation in pigs during low flow sigmoideal ischemia in combination with hypovolemic shock. This condition resembles the situation that occurs in patients suffering from a ruptured aneurysm and a compromised colonic circulation. An experimental study in pigs was performed: 6 pigs with low flow sigmoideal ischemia and hypovolemic shock were treated with valsartan and a control group of 5 pigs with low flow sigmoideal ischemia and hypovolemic shock without medical treatment. Valsartan, 3 mg/kg, was administered intravenously. The operation was performed via left sided lumbotomy. The distal aorta was partially occluded to a flow reduction of 30% of the initial value. Hypovolemic shock was induced by withdrawing 20 ml/kg blood in 45 min. Resuscitation with 30 ml/kg haemaccel was iniated after 2 h of shock. The following parameterswere measured: blood pressure, cardiac output; hemoglobin, lactate, angiotensin II in mixed venous blood (obtained from pulmonary artery) and in splanchnic blood (obtained from caudal mesenteric vein); and endoluminal pulse oximetry of the sigmoideal mucosa. Statistical analysis was performed by ANOVA and Wilcoxon signed rank test. There was a significant increase of lactate levels both in systemic and splanchnic circulation (P<0.05) in both groups. In the control group, the mean angiotensin II concentrations in the systemic circulation increased, after induction of ischaemia and shock. In the experimental group, the increase in angiotensin concentrations after resuscitation was significantly more prominent. In the colonic circulation, in both groups, there was a significant increase in angiotensin II levels in the splanchnic circulation following ischaemia and reperfusion (P<0.05), but there was no significant difference between the groups. There were no detectable mucosal signals measured by pulse oximetry after induction of shock throughout the experiment, whereas in the experimental group, median mucosal oxygen saturations of 81. 74.5 and 85% were achieved after resuscitation and declamping (P<0.01). In conclusion, angiotensin II inhibition during hypovolemic shock improves the colonic circulation, measured by pulse oximetry. However, other parameters of tissue ischaemia did not improve.
Hemodynamics of Infrapopliteal PTFE Bypasses and Adjunctive Arteriovenous Fistulas
Authors: Kallakuri S. , Ascher E. , Hingorani A. , Jacob T. , Salles-Cunha S. 
Published: September 2022

Purpose Blood flow, pressure and peripheral resistance in patients with established polytetrafluoroethylene (PTFE) grafts and adjunctive arteriovenous fistulas (AVF) have rarely been investigated. To better elucidate the effects of this AVF, we obtained noninvasive measurements of hemodynamic variables in patients with infrapopliteal PTFE grafts and an AVF. Methods Systolic, mean and diastolic arm and toe pressures were measured with an oscillometric technique employed in automatic blood pressure monitors. Peak-systolic velocity, end-diastolic velocity and flow rates at the graft and recipient distal artery were measured with duplex ultrasound. Resistance for the leg and foot in peripheral resistance units (PRU) was estimated as mean arm pressure divided by graft flow rate and as mean toe pressure divided by distal artery flow rate respectively. We analyzed data from 21 patients. Toe pressures were measurable in 13 patients. Bypass graft inflow was at the external iliac artery in 11 patients, common femoral in six, common iliac in two and superficial femoral in two. The distal anastomosis was at the anterior tibial artery in 10 patients, peroneal in seven and posterior tibial in four patients. Results Graft systolic and diastolic velocities were 91 ± 46 (mean±sd) and 38 ± 31 (mean±sd) cm/s respectively. Toe systolic pressure averaged 81 ± 28 (mean±SD) mmHg with a corresponding toe/brachial index (TBI) of 0.53 ±0.18 (mean±SD). The ratio between arm mean pressure, 104 ± 20 (mean±SD) mmHg, and graft flow rate, 413 ± 290 (mean±sd) ml/min, yielded an estimated leg resistance of 0.32 ± 0.20 peripheral resistance units (PRU) (mean±sd). The ratio between mean toe pressure, 51 ± 21 (mean ± SD) mmHg, and distal artery flow rate, 37 ± 26 (mean±SD) ml/min, produced an estimated foot resistance averaging 1.66 ± 1.18 PRU (mean±sd). Conclusions Average graft flow rate was five times greater than flow reported for standard tibial bypasses. Although distal artery flow rate and graft peak systolic velocity were within reported normal ranges, mean toe pressure and toe-brachial index were below normal. Leg and foot resistances were decreased. These data suggest that bypasses with arteriovenous fistulas have increased flow, desirable for graft patency, but may affect distal perfusion pressure.
Risk Factors Influencing the Outcome after Surgical Treatment of Complicated Deep Sternal Wound Complications
Authors: Peivandi A. A. , Kasper-König W. , Quinkenstein E. , Loos A. H. , Dahm M. 
Published: September 2022

Background: Median sternotomy is the most frequently used incision for cardiac procedures but carries a substantial risk for deep sternal wound infections and/or sternal dehiscence. In contrast to previous studies that examined risk factors for sternal infections this study evaluates factors that lead to poor outcome after surgical revision of the non healing sternum. Methods: Between 1985 and 1999, 193 adults (mean age 64 ± 9 years, m/f = 3/1) necessitated sternal revisions (incidence 1.93%). Pre-, intra- and post-operative risk factors were evaluated for their influence on the outcome after sternal revision. Results: 65 of the 193 patients had a complicated course: ten (5.2%) died due to sepsis/multi organ failure ( n = 6) or cardiac causes ( n = 4). 32 patients (16.6%) needed several revisions, 17 (9%) were discharged with sternal instability, 5 (3%) with chronic fistula and one with persistent osteomyelitis. Univariate and multivariate analysis identified cardiopulmonary resuscitation (odds ratio ( OR) = 11.188, p = 0.010), corticoid treatment ( OR = 7.043, p = 0.0055), diabetes ( OR = 4.130, p = 0.0128), smoking history ( OR = 2.996, p = 0.0041), renal insufficiency (hazard ratio ( HR) = 1.884), old age ( OR = 1.108, p = 0.0266), high body mass ( HR = 1.06), ECC time ( p = 0.023), cross clamp time ( p = 0.028), systemic hypothermia ( p = 0.016), non-use of IMA ( p = 0.042) or prolonged ventilation as risk factors for mortality or poor outcome. No correlation between sternal closure technique, mediastinal irrigation or antibiotic therapy and outcome after mediastinal revision could be found. Conclusions: To avoid disappointing results after sternal revision one should aim to preoperatively identify high-risk patients and aggressively address risk factors. This rather than modifications of the surgical and medical approach might improve the outcome of patients with mediastinal complications.
Can ε-Aminocaproic Acid Balance the Off-Pump Bleeding Advantage?
Authors: Stassano P. , Musumeci A. , Santise G. , Gagliardi C. , Montalto A. , Spampinato N. 
Published: September 2022

Background: Aprotinin improved the control of bleeding in patients undergoing surgery with cardiopulmunary bypass, but its use was halted because of the risk of bovine spongiform encephalopathy. We then started to use ε-aminocaproic acid and the results in the control of bleeding were satisfactory. To assess its effectiveness in the control of postoperative bleeding precisely, we compared the results for patients operated on for myocardial revascularization on-pump and treated with ε-aminocaproic acid with those for patients who decidedly bleed less: off-pump patients. Methods: Two groups of patients who had had either on- or off-pump double aortocoronary bypass surgery were retrospectively reviewed for postoperative bleeding. These two almost homogeneous group had two grafts only: left anterior descending and circumflex arteries operated on with cardiopulmonary bypass and treated with the ε-aminocaproic acid, and left anterior descending and right coronary arteries operated on off-pump. Results: Postoperative bleeding through chest drainage at 4 h was 265 ± 91.7 mL in the off-pump group and 328.4 ± 131.4 mL in the on-pump group ( p = 0.004). But at 24 h it was 671.6 ± 311.5 mL in the off-pump group and 827.8 ± 514.4 mL in the on-pump group ( p = 0.07). Conclusions: ε-Aminocaproic acid is effective in controlling postoperative bleeding in patients operated on for myocardial revascularization with the aid of cardiopulmonary bypass.
Tuberculous Abdominal Aortic Pseudoaneurysm Penetrating the Left Psoas Muscle after BCG Therapy for Bladder Cancer
Authors: Wada S. , Watanabe Y. , Shiono N. , Masuhara H. , Hamada S. , Ozawa T. , Fujii T. , Yokomuro H. , Kawasaki M. , Yoshihara K. , Koyama N. 
Published: September 2022

We describe a case of a 75-year-old man with abdominal aortic and right femoral tuberculous pseudoaneurysms 32 months after intravesical bacillus Calmette-Guerin therapy for bladder cancer. These aneurysms were probably brought on by systemic infection by Mycobacterium bovis. The infrarenal aorta and right common femoral artery were successfully replaced with an in situ expanded polytetrafluoroethylene graft. Tuberculous pseudoaneurysm after bacillus Calmette-Guerin therapy for malignancy is very rare, and we review the related literature.
Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections
Authors: Driever R. , Botsios S. , Schmitz E. , Donovan J. , Vetter H. O. 
Published: September 2022

Background: To evaluate long-term effectiveness of strategies for managing the aortic root and distal aorta in type A dissections. Methods: From 1990 to 1999, 50 patients (32 men, 64.07%; 18 women, 36.0%; mean age 57.4 y ± 11.1) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%). Results: Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long term survival and proximal re-operations. The ascending aorta alone was replaced in 8/50 patients (16%), ascending and hemiarch in 30/50 patients (60%) and arch and proximal descending aorta in 12/50 patients (24%) Hospital mortality (11.5, 20.0 and 16.7% respectively; p > 0.05) and 5- and 10-year survival ( p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality ( p > 0.05) and 5 year survival ( p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%). Conclusions: Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery.
Operative Risk Factors of Type A Aortic Dissection: Analysis of 252 Consecutive Patients
Authors: Tan M. Erwin S. H. , Dossche Karl M. E. , Morshuis Wim J. , Knaepen Paul J. , Defauw Jo J. A. M. , van Swieten Henry A. , van Boven Wim-Jan , Kelder Johannes C. , Waanders Frans G. J. , Schepens Marc A. A. M. 
Published: September 2022

Objective: We examined operative risk factors for postoperative death after surgery for acute type A aortic dissection. Methods: Between 1974 and 1999, 252 patients, 163 men and 89 women (mean ± SD age, 58 ± 12 years) underwent surgery for acute type A aortic dissection. Fifty-eight (23.0%) were in cardiogenic shock at time of surgery. Most patients underwent ascending aorta replacement which was combined with aortic valve replacement by means of a composite graft in 30 (11.9%) patients and an isolated aortic valve replacement in 16 (6.3%) patients. Results: The overall operative mortality rate was 25.0% ( n = 63); 27.0% for patients operated upon with aortic cross-clamping, 23.7% after deep hypotherm circulatory arrest and 23.3% after antegrade selective cerebral perfusion (ASCP) ( p = 0.73). Multivariate analysis revealed iatrogenic dissection ( p = 0.0096, odds ratio = 5.7), preoperative cardiopulmonary resuscitation ( p = 0.0095, odds ratio = 5.5) and every quarter of an hour longer extracorporeal circulation ( p = 0.049, odds ratio = 1.1) as independant risk factors for operative mortality. Aortic valve replacement or Bentall procedure ( p = 0.0185, odds ratio = 0.3) were protective factors. There were 44 new postoperative strokes: 4.7% in the group operated upon with and 20.1% in the group without ASCP ( p = 0.01). Conclusion: In order to avoid cardiogenic shock and preoperative cardiopulmonary resuscitation, patients with acute type A aortic dissection should be treated promptly. The choice to use an aortic valve prosthesis or Bentall procedure when applicable seems to benefit the postoperative early survival. The risk of new postoperative neurological events might be reduced by avoiding the appliance of an aortic cross-clamp and by using ASCP.
Endoluminal Aortic Shunting for Distal Perfusion during Thoracic Aortal Cross-Clamping in a Pig Model
Authors: Ditmarsch M. , Yilmaz E. N. , Vahl A. C. , van Genderingen H. R. , van Rij G. L. , Rauwerda J. A. 
Published: September 2022

Purpose of the study: To investigate the haemodynamic properties of a direct endovascular aortic shunt to maintain distal aortic perfusion as an alternative of a distal shunt (left-left-,Gott shunt) in thoracic aortic aneurysm repair. Methods: A shunt was developed and tested in an in vitro model which should be capable of transporting a flow of 3–4 L/min with a decrease in blood pressure < 20 mmHg. Thereupon the shunt was tested in an in vivo experiment in six pigs to assess the possibility of its use with normal distal blood pressure. The shunt was inserted in the thoracic aorta and stayed in place for 1.5 h. Parameters were measured at six time intervals to assess organ perfusion, -function, cardiac output, proximal- and distal blood pressure and aortic- and shunt flow. Principle findings: The mean blood flow through the shunt was 2.5 L/min. The difference of the mean blood pressure over the shunt was on average 14.20 mmHg. Parameters for coagulation disturbance and organ ischaemia were tested. The decrease in mean trombocyt count was 299–158 ( p < 0.02). The venous lactate and the venous mesenteric lactate as parameters for intestinal ischemia did not increase significantly. No significant changes occurred in angiotensin II levels. Pulsatile flow was maintained but significantly suppressed (60%) distal from the shunt. The clamp time needed to insert the shunt and the venous mesenteric lactate, as well as the venous lactate, showed high correlation, r s = 0.9 ( p < 0.05) and r s = 0.94 ( p < 0.01). This also accounted for the 2nd clamp time, both r s = 0.95 ( p < 0.05). Conclusion: The shunt is capable of transporting a blood flow of 2–4 L/min with an acceptable decrease in distal blood pressure. However, the time, needed to insert the shunt, was significantly associated with parameters of organ ischaemia.
Integrated Approach to Off-Pump Coronary Artery Bypass Surgery
Authors: Al-Ruzzeh S. , Amrani M. , Boscoe M. , Farrimond J. , Riedel B. , Wright I. , George S. 
Published: September 2022

Background: The Off-Pump Coronary Artery Bypass (OPCAB) technique is becoming more popular in many cardiac units throughout the world. This relatively new technique has prompted surgeons and anaesthetists to review and modify the routine approach to Coronary Artery Bypass Surgery (CABG). In this study we reviewed and analysed the outcome of an integrated anaesthetic and surgical peri-operative approach that allowed routine use of OPCAB and avoided the use of cardiopulmonary bypass (CPB). Methods: We reviewed and analysed the data on the first consecutive 285 patients who were operated on using the OPCAB technique. These represent our initial experience with applying the OPCAB technique non-selectively for all patients over a period of 16 months. Results: All patients had at least 2-vessel disease. 807 grafts were performed (mean 2.8 per patient) of which 647 (80%) were arterial (mean 2.3 per patient). 179 (63%) patients underwent total arterial revascularization. Eight patients required cardiopulmonary bypass; all other operations were completed off-pump. Complications — mortality 3 (1%); renal failure 24 (8%); stroke 3 (1%) and atrial fibrillation 60 (21%). Conclusion: This retrospective analysis shows that provided a combined and integrated anaesthestic and surgical approach is used, beating heart technique for CABG can be safely offered to all patients with a good outcome.