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Biomedical subjects

A J DelRossi

Publications and source records attributed to A J DelRossi.

At least 37 records · Page 2Linked to original sources
PubMed1992

Transfusion guidelines for cardiovascular surgery: lessons learned from operations in Jehovah's Witnesses.

Patients undergoing cardiovascular surgery are among the top users of homologous blood transfusion (HBT). Awareness of the risks of disease transmission and immune system modulation from HBT has prompted us to find alternatives such as autologous predonation (APD) and intraoperative autotransfusion (IAT). However, these latter options are not appropriate for all patients. We reviewed our experience with 59 Jehovah's Witness patients who underwent 63 elective cardiovascular procedures without either HBT or APD to determine the safety of operation without these modalities and to develop revised maximum surgical blood-ordering schedule guidelines for cardiovascular surgery. Estimated blood loss averaged 870 ml, but one third to one half of losses were replaced by IAT. IAT was not needed in lower extremity bypass operations in which the estimated blood loss was less than 150 ml. Three of 59 patients died (5.1%), but only one died of operative bleeding complications. We conclude that (1) elective cardiovascular operations can be done safely without the use of either HBT or APD, (2) HBT is not necessary in leg bypass procedures, and (3) maximum surgical blood-ordering schedule guidelines for HBT in major cardiovascular operations can be reduced to near zero by the use of intraoperative autotransfusion and acceptance of a postoperative hemoglobin nadir of 7.0 gm/dl.

Blood Loss, Surgical↗
PubMed1992

Determinants of outcome in lesions of the thoracic aorta in patients with multiorgan system trauma.

Of all patients presenting at our level 1 trauma center with multiorgan system injuries, 33 have been identified with acute lesions of the thoracic aorta. Mean severity injury score was 24 +/- 3. Four patients underwent resuscitative thoracotomy upon arrival in the emergency department. One survived and fully recovered. The rest underwent diagnostic procedures and repair of aortic lesions in conjunction with surgical treatment of other injured organ systems. The overall survival rate was 82 percent. Survivors arrived significantly faster to the ED and had lesser degree of multiorgan system injuries. There was no difference in the time spent to make the diagnosis of acute aortic disruption for survivors and nonsurvivors, nor was a difference in time to arrive in the operating room once the diagnosis of aortic injury has been established. Morbidity was related to ischemia to distal organs in four patients of whom two presented with multiple lesions of the thoracic aorta; two remained paralyzed and two had only lower limb spasticity. All discharged survivors were alive at 12 months' follow-up. The type of surgical repair did not influence the outcome of patients with single, typical aortic lesions; however, "clamp/sew" technique was not adequate when multiple aortic tears were found intraoperatively. The outcome of surgical treatment of the traumatic aortic lesions of patients with polytrauma may be influenced by the speed of arrival to the ED, the magnitude of multiorgan system involvement, and the application of appropriate surgical technique for repair according to the intrathoracic findings and the timing of aortic repair vis-a-vis other surgical treatment.

Aorta, Thoracic↗
PubMed1991

Silicone pouch for protection of automatic implantable cardioverter-defibrillator leads.

Automatic implantable cardioverter-defibrillator has become routine treatment for recurrent, drug-resistant ventricular tachycardia. Although there is documentation regarding clinical experience and device performance, there is little information on how to avoid complications related to the retrieval of sensing and defibrillation leads from the subcutaneous space. We are reporting our experience with a silicone pouch for protection of automatic implantable cardioverter-defibrillator leads that allows immediate and simple retrieval of the leads in case an automatic implantable cardioverter-defibrillator generator is needed.

Adult↗
PubMed1991

Ventricular free-wall rupture after myocardial infarction. Treatment and outcome.

Ventricular free-wall rupture remains one of the leading causes of death after myocardial infarction (MI). With increased abilities for diagnosis and resuscitation techniques, surgical correction of free-wall myocardial defects resulting from ischemia and necrosis may become a simple modality of treatment, resulting in improvement of the survival rate. We are reporting our experience with four patients with ventricular free-wall rupture after MI, with emphasis on clinical presentation, diagnosis, and surgical management.

Aged↗
PubMed1991

Arterial-venous perfusion without anticoagulation: the impeller centrifugal pump.

A study was designed to test the effects of the absence of anticoagulation in the extracorporeal circuit. Five swine were subjected to this experiment utilizing the impeller centrifugal pump during which neither heparin nor any other anticoagulant was used. The extracorporeal circuit consisted of polyvinylchloride tubing, a Centri-Med pump and an external stainless steel heat exchanger that was primed with albuminized Ringer's solution. An arterial-venous circuit was employed with oxygenation supplied from the subject's lungs. A series of blood aliquots were analyzed for coagulation at various times throughout the procedure. Following total body cooling using topically applied ice water, the subjects were rewarmed utilizing bypass. Within 10 minutes after the initiation of bypass, the circuits became clotted, rendering perfusion and subsequent warming ineffective. The lab values indicated that intrinsically activated coagulation occurred upon exposure to the extracorporeal apparatus. Flow visualization studies revealed a source of stagnant blood flow in the area around the hub of the pump head. Blood clot was similarly located in this area, with clot extension throughout the return circuit being realized. It is imperative that areas of stagnation be eliminated from extracorporeal circuits, since they may be potential sites for clot formation.

Animals↗
PubMed1990

Heparinless extracorporeal bypass for treatment of hypothermia.

In an attempt to assess the changes occurring to the coagulation profile during internal active core rewarming with partial cardiopulmonary bypass (CPB) without heparin anticoagulation, five pigs were anesthetized, and a model for severe to moderate hypothermia was created. Femoral-femoral bypass with Bio-Pump, heat exchanger, and a membrane oxygenator were used during the rewarming for 64.8 +/- 8.5 minutes. There were no statistically significant changes in platelet count, platelet index, activated clotting time (ACT), partial thromboplastin time (PTT), prothrombin time (PT), fibrinogen, fibrinogen index and fibrin split products (p greater than 0.05). There were no thromboembolic sequelae seen at autopsy. The components of the CPB circuit showed no signs of formation of aggregates or thrombi. The results of this study are attributed to the nonthrombogenic, atraumatic design of the Bio-Pump and the enhanced physiological fibrinolysis seen in the first hour of CPB. We concluded that heparinless CPB may serve as a safe alternative for active core rewarming for severe to moderate hypothermia.

Animals↗
PubMed1990

Multiple traumatic disruptions of the thoracic aorta.

Surgical therapy for acute traumatic transection of the thoracic aorta is widely debated in the literature. However, little is published regarding therapy for unusual intraoperative findings, especially when the existence of multiple tears of the aortic wall would increase the operative difficulties and the associated risks. Our report concerns the presentation of three consecutive cases where multiple traumatic transections of the thoracic aorta could not be diagnosed by standard preoperative techniques. Our attention is focused on different technical options and their outcome when unusual intraoperative findings are present. We concluded that the event of unusual intraoperative findings may change the initial surgical management in favor of a more definitive procedure which usually carries a longer aortic cross-clamp time. In this instance, the availability of cardiopulmonary bypass (CPB) techniques is warranted.

Accidents, Traffic↗
PubMed1990

Traumatic disruptions of the thoracic aorta: treatment and outcome.

Of 27 patients admitted to our level I trauma center with acute disruption of the thoracic aorta, two patients died of exsanguination before aortic repair. One patient had massive leakage from the aneurysm after aortography and died during surgery. All patients suffered from multiple injuries. Eighty-three percent of the patients had major operations in addition to the aortic repair. "Clamp and sew" technique was used in 18 patients (75%), two of whom had multiple tears of the aortic arch. Heparin-coated shunts were used in five patients (20.8%), and a cardiopulmonary bypass was performed in one patient who had multiple tears. Three postoperative deaths were related to polytrauma, cardiogenic shock, and sepsis. Paraplegia developed in three patients, two of whom had multiple aortic lesions necessitating longer ischemia time during the repair. Only one patient had complete neurologic deficit at the 1-year follow-up. In our series, neither surgical procedure proved superior. We conclude that the "clamp and sew" technique for repair of the disrupted thoracic aorta may allow for a more favorable outcome.

Adult↗
PubMed1990

Preventive effect of Fluosol-DA for paraplegia encountered after surgical treatment of the thoracic aorta. Preliminary results in a dog model.

The effectiveness of Fluosol-DA (Green Cross Corporation, Osaka, Japan) on circulatory dynamics and neurologic outcome in dogs with ischemic spinal cord injury produced by aortic crossclamping was tested. The control group (receiving saline solution) had an elevated mean aortic proximal pressure (112.9 +/- 30.2 mm Hg versus 175.3 +/- 20.5 mm Hg, p greater than 0.05) and a drastic drop in mean distal aortic pressure (112.9 +/- 30.2 mm Hg versus 29.8 +/- 11.2 mm Hg, p less than 0.05). Although the same trend occurred in dogs treated prophylactically with Fluosol-DA, these changes were not statistically significant. However, there was a significant difference in mean distal aortic pressure during the ischemic phase between the two groups (58.9 +/- 16.0 mm Hg versus 29.8 +/- 11.2 mm Hg, p less than 0.05). Postoperatively all animals had mean arterial pressures within the normal range. All dogs in the control group were paraplegic (partial or complete); the treatment group had one dog with partial paraplegia. The difference between the mean neurologic scores of the two groups was of high statistical significance (3.7 +/- 0.5 versus 1.6 +/- 1.0, p less than 0.05). Our preliminary results show that prophylactic use of Fluosol-DA has favorable effects on hemodynamics and neurologic outcome in dogs with spinal cord ischemia produced by aortic crossclamping. The high propensity of the drug to carry oxygen and carbon dioxide and to provide nutritional support to the ischemic area with resultant improvement in local microcirculation and blood rheology are some speculative mechanisms advocated for these changes.

Animals↗
PubMed1990

Platelet-rich plasma reduces postoperative blood loss after cardiopulmonary bypass.

To study the effect of plasma sequestration and reinfusion of platelet-rich plasma on blood loss after cardiopulmonary bypass, 18 patients undergoing heart operations were randomly selected either to have collected or not to have collected approximately 250 ml of platelet-rich plasma before initiating cardiopulmonary bypass with the use of the Haemonetics Plasma Saving System (Haemonetics Corporation, Braintree, Mass.). All patients had standardized anesthesia and cardiopulmonary bypass. After reversal of heparin, autologous platelet-rich plasma was reinfused in nine patients. Thrombocyte counts, hemoglobin, and hematocrit were calculated before, during, and after cardiopulmonary bypass, and 24 and 48 hours postoperatively. Blood loss and total number of transfusions were recorded. Although 9% of the total platelet volume was removed, there were no hemodynamic complications related to the use of the Haemonetics Plasma Saving System. In both groups, significant low levels of thrombocytes, hemoglobin, and hematocrit were seen after cardiopulmonary bypass. Platelet-rich plasma-reinfused patients had a significantly higher number of platelets after heparin reversal. They also had significantly less blood loss after the operation, necessitating 65% less banked blood products (p less than 0.05). We concluded that reinfusion of autologous platelet-rich plasma may serve as an effective and safe way to restore some of the hematologic derangements after cardiopulmonary bypass.

Blood Platelets↗
PubMed1989

Prophylactic treatment of postperfusion bleeding using EACA.

To determine the effects of prophylactic treatment with EACA for blood loss after cardipulmonary bypass surgery, 350 consecutive patients undergoing open-heart surgery were studied. One hundred seventy patients received an initial dose of 5 g of EACA prior to skin incision, followed by intravenous administration of 1 g/h for the next 6 to 8 h. The control group received saline solution in the same fashion. The EACA-treated group had decreased chest tube blood loss 24 h postoperatively. In addition, EACA-treated patients had fewer myocardial infarctions, cerebrovascular accidents or reoperations for bleeding. Treated patients needed fewer units of blood transfusions than the nontreated group. There was no incidence of hyperthrombotic state or other side effects in the EACA-treated group. We concluded that prophylactic treatment with EACA for open-heart surgery requiring extracorporeal circulation may reduce the total blood loss and the number of blood transfusions in a safe and tolerable manner.

Aminocaproates↗
PubMed1989

Right ventricular myocardial protection through intracavitary cooling in cardiac operations.

In an attempt to protect the right ventricle, we designed and tested a closed cooling system that circulates cold saline through a double-lumen, balloon-tipped catheter positioned in the right ventricular cavity. Fourteen sheep were randomly assigned to two groups. In group A (n = 7), the right ventricular cooling catheter system was used in addition to coronary cardioplegic perfusion and systemic hypothermia for myocardial protection. Group B (n = 7) served as a control group. In group A, the right ventricular temperatures were significantly lower than those of the control group (16.1 degrees +/- 0.3 degrees C versus 23.9 degrees +/- 0.4 degrees C; p less than 0.0001, Student's t test). The most common temperature range was 12 degrees to 18 degrees C (67.1%, frequency distribution analysis), and 63.2% of temperatures were below 16 degrees C. The catheter system also maintained the temperatures of the interventricular septum at a lower level than those recorded in the control group and prevented septal rewarming, which was significant in group B (from 16.5 degrees +/- 1.5 degrees C to 25.0 degrees +/- 0.9 degrees C; p less than 0.04, Mann-Whitney U test). Left ventricular temperatures were not changed by the catheter system. By better cooling the right ventricle and the septum, the right ventricular cooling catheter system should decrease the prevalence of right ventricular failure and allow more time to safely complete multiple coronary anastomoses in coronary artery bypass graft operations.

Animals↗
PubMed1984

Redundant pacing: case report and review.

A 17-year-old boy with severe sick sinus bradycardia had a doubly redundant pacemaker inserted. With two separate ventricular leads inserted by the epicardial route, the pacemaker is able to compensate for a lead that has developed high threshold by activation of an alternate lead. The two pacing channels of the pulse generator can be programmed independently of one another. In addition, there is a back-up pacing circuit separate from the two primary channels. The pacer can be used with both channels active for continuous automatic redundancy for safety, or with one channel active and the other in reserve.

Adolescent↗
PubMed1983

A new retractor to aid in coronary artery surgery.

During coronary artery bypass grafting, exposing the arteries can be difficult, especially on the posterior and lateral aspects of the left ventricle. A silicone-covered flexible retractor has been modified to facilitate this procedure. Its central opening and easy malleability aid in myocardial retraction and coronary artery bypass grafting.

Coronary Artery Bypass↗
PubMed1980

Successful management of Penicillium endocarditis.

Penicillium endocarditis involving an aortic valvular tissue prosthesis (Ionescu-Shiley) was successfully managed. This is the fourth reported case of Penicillium endocarditis, and the first survivor. A review of the literature shows that this fungus is ubiguitous though rarely pathogenic. The management of this rare type of infection is outlined.

Adult↗
PubMedDate not supplied

A sheep model for thoracic aortic surgery in the presence of systemic coagulopathy.

Surgical repair of aneurysms, traumatic injuries, or congenital anomalies of the thoracic aorta are associated with high morbidity and mortality mainly as a result of excessive and uncontrollable hemorrhage from diffuse coagulopathy. We developed a model in sheep that simulates this coagulopathic state for experimentation with thoracic aorta surgery. This experimental animal model involves administering a 600-mg aspirin suppository once a day for the 2 days preceding surgery and a final dose on-call to surgery. Prior to cross-clamping the aorta, an intravenous (i.v.) bolus of heparin (400 IU/kg) was administered. Thirty minutes later, the i.v. heparin bolus was repeated. Pre- and intraoperative activated clotting time was 101 +/- 10 s and >1500 s (p < .0001); prothrombin time, 21 +/- 1 s and >100 s (p < .0001); and activated partial thromboplastin time, 20 +/- 1 s and >50 s (p < .0001), respectively. We utilized a partial cross-clamp-and-sew technique to anastomose a woven, gelatin-impregnated, 16-mm tube graft end-to-side to the descending thoracic aorta. Mean total blood loss was 1367 +/- 282 mL, which included mean blood loss from time of release of aortic cross-clamp to close (422 +/- 135 mL) and mean total blood output from chest tube drain (945 +/- 203 mL). The mean time to achieve hemostasis at suture lines after aortic cross-clamp release was 15.5 +/- 6.6 min. In conclusion, a sheep model with induced coagulation defects was successfully developed and reproducible for experimentation involving thoracic aortic surgery.

Anastomosis, Surgical↗
PubMedDate not supplied

Transmyocardial laser revascularization: current status.

Transmyocardial laser revascularization (TMLR) has been widely evaluated for treatment of the ischemic myocardium either in conjunction with coronary artery bypass grafting or as sole therapy. Clinically, it has shown significant improvement for angina symptoms, but the mechanism by which this modality works is unknown at this time. The original premise on which transmyocardial revascularization was established depended on its ability to essentially generate channels that would directly carry blood from the ventricle into the ischemic myocardium. This theory, however, has not been substantiated, so other mechanisms have been postulated. This article gives a historical perspective on the advent of transmyocardial revascularization and the many animal and human studies that have paved the way for its clinical use. Current controversies are examined, along with the new advances in laser technology and where the future of TMLR is headed.

Animals↗