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  • 1
    Electronic Resource
    Electronic Resource
    Risk Factors for Stroke Following Coronary Bypass Surgery (1995)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 10 (1995), S. 0 
    Details
    ISSN: 1540-8191
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Improvements in surgical technique and advances in myocardial protection have resulted in low rates of morbidity and mortality despite a greater incidence of high-risk patients. Noncardiac morbidity prolongs hospital stays and increases the costs of cardiac surgery. This study examines the preoperative predictors of stroke following isolated coronary bypass surgery. The clinical records of 3910 consecutive patients who underwent isolated coronary bypass surgery at the University of Toronto were reviewed. Stepwise logistic regression identified six independent predictors of stroke following CABG (percent in parentheses) and calculated factor adjusted odds ratios (OR) for each risk factor. Triple vessel coronary artery disease was the most important predictor (1.9%, OR 5.71), followed by normothermic systemic perfusion (3.8%, OR 4.85), age 〉 70 years (3.2%, OR 3.88), a previous history of transient ischemic attacks or stroke prior to surgery (6.1 %, OR 3.7), peripheral vascular disease (4.7%, OR 2.77), and diabetes mellitus (2.6%, OR 2.01). The mechanism of stroke is likely different between these high-risk groups and strategies to prevent postoperative stroke should focus on the mechanisms responsible in high-risk patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8191.1995.tb00679.x
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  • 2
    Electronic Resource
    Electronic Resource
    Left ventricular diastolic function of the reperfused postischemic donor heart (1993)
    Springer
    Surgery today 23 (1993), S. 902-907 
    Details
    ISSN: 1436-2813
    Keywords: cardioplegia ; diastolic function ; donor heart ; calcium
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study examined the pathophysiological relationship between left ventricular diastolic function and myocardial biochemical changes during reperfusion following hypothermic cardioplegic preservation of the donor heart. Isolated canine hearts (n=47) were preserved for 6 h at 5°C, followed by normothermic reperfusion for 2 h. Regression analysis demonstrated a highly significant correlation between: Left ventricular maximum −dp/dt and the left ventricular end-diastolic pressure (r=−0.56, P=0.001); myocardial concentrations of adenosine triphosphate (ATP) and Ca2+ (r=−0.59, P=0.0001); maximum −dp/dt and myocardial concentrations of: (1) ATP, (2) Ca2+, and (3) total adenine nucleotide with left ventricular volume loading (r=−0.53, P=0.003, r=0.51, P=0.002; and r=0.52, P=0.002, respectively); and left ventricular end-diastolic pressure and myocardial Ca2+ (r=0.66, P=0.0001). These results suggest that left ventricular relaxation, as assessed by maximum −dp/dt, has a negative correlation with left ventricular stiffness, as determined by the end-diastolic pressure in preserved donor hearts. Furthermore, increased myocardial Ca2+ concentrations reflect exhaustion of myocardial ATP. Thus, the myocardial Ca2+ concentration correlates directly with wall stiffness and inversely with ventricular relaxation, while ATP concentration correlates directly with ventricular relaxation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00311370
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  • 3
    Electronic Resource
    Electronic Resource
    The effect of sodium concentration on myocardial viability in donor heart preservation using a nondepolarizing solution (1994)
    Springer
    Transplant international 7 (1994), S. 109-114 
    Details
    ISSN: 1432-2277
    Keywords: Heart preservation, dog ; Preservation, heart, dog ; Sodium, heart preservation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study examined the effect of different sodium concentrations in a nondepolarizing solution on myocardial viability and functional recovery of the canine donor heart. Isolated canine hearts were preserved for 6 h at 5°C, followed by normothermic reperfusion for 2 h. Dogs were divided into two groups of nine dogs each: group 1 received a nondepolarizing solution with 70mm Na+ and group 2 with 30mm Na+. The myocardial Ca2+ concentration at the end of preservation was significantly higher in group 1 than in group 2 and increased after reperfusion in both groups without any intergroup difference. Myocardial concentrations of ATP, ADP, and total adenine nucleotide at the end of reperfusion were significantly higher in group 1 than in group 2. Myocardial cyclic adenosine monophosphate concentration was significantly higher in group 1 than in group 2 at the end of both preservation and reperfusion. The myocardial cyclic guanosine monophosphate concentration in group 1 increased and was higher than in group 2 at the end of preservation, but had returned to normal levels by the end of reperfusion. However, it remained unchanged through preservation and reperfusion in group 2. The left ventricular systolic and diastolic function, assessed by pressurevolume relationship, was better in group 1 than in group 2. Mitochondrial ultrastructural changes were similar. These results suggest that a nondepolarizing solution containing 70mm Na+ provides better myocardial protection than a solution containing 30mm Na+.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00336471
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