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Graham Cooper

Publications and source records attributed to Graham Cooper.

9 recordsLinked to original sources
PubMed2006

Above-knee vein harvest for coronary revascularization increases ASEPSIS score.

The long saphenous vein may be harvested from the thigh or the lower leg, depending on the operating surgeon's preference. This prospective study compared the incidence of altered wound healing between these two sites in 175 patients undergoing routine coronary artery bypass grafting over a 3-month period. The patients were divided into 3 groups. In group A, the vein harvest site was restricted to above the upper border of the patella. Group B included harvest sites that started at the ankle but extended above the level of the upper border of the patella. In group C, the vein harvest site was restricted to below the upper border of the patella. The wounds were assessed daily using the ASEPSIS scoring system. In group A, significantly more patients (24%) had an ASEPSIS score > 10, compared to group B (3%) and group C (2%). The mean ASEPSIS score was significantly lower in group C than groups A or B, 1.5 +/- 2.4 vs. 6.5 +/- 3.2 or 3.7 +/- 1.7, respectively. The ASEPSIS score is reduced when vein harvest is restricted to below the level of the knee.

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PubMed2005

Comparison of two strategies for the management of antiplatelet therapy during urgent surgery.

BACKGROUND: The optimal management of aspirin and clopidogrel therapy before surgery in patients with acute coronary syndrome is uncertain. Aspirin and clopidogrel within 5 days of surgery increases postoperative bleeding and reexploration. However, in acute coronary syndrome patients the risk of bleeding must be balanced against the risks of discontinuing the treatment and delaying surgery. METHODS: From June 2002 to July 2003, patients undergoing urgent coronary artery bypass graft surgery (CABG) for acute coronary syndrome were randomly assigned to one of two groups. The treatment group remained on aspirin and clopidogrel therapy till surgery, receiving intraoperative aprotinin. The placebo group received placebo for 5 days before surgery and received placebo infusions intraoperatively. Platelet reactivity in response to adenosine diphosphate was assessed by whole blood single-platelet counting. Of the 88 patients eligible, 50 entered the study. RESULTS: Postoperative blood loss was significantly greater in the placebo group than in the treatment group (702 +/- 120 mL versus 446 +/- 62 mL, p = 0.004). This difference was observed as early as 8 hours postoperatively (385 +/- 66 mL versus 266 +/- 36 mL, p = 0.03). Patients in the placebo group also required more blood transfusions (1 +/- 0.3 units versus 0.3 +/- 0.2 units, p = 0.03). Three patients in each group underwent surgical reexploration for bleeding. CONCLUSIONS: The strategy of continuing aspirin and clopidogrel therapy with intraoperative aprotinin reduces postoperative blood loss, transfusion requirements, prevents delay to surgical treatment, and may prevent major adverse cardiac events before surgery.

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PubMed2003

A prospective randomised comparison of cardiotomy suction and cell saver for recycling shed blood during cardiac surgery.

OBJECTIVE: Post-operative neuropsychological complications correlate with intra-operative microemboli in the middle cerebral artery. When severe neurological complications follow cardiac surgery, diffuse cerebral fat emboli are present at autopsy. Recycling shed blood with cardiotomy suction is an important source of cerebral fat microemboli. A cell saver may reduce this. METHODS: Twenty patients were prospectively randomised to assess the amount of fat in blood salvaged from the pericardium and returned to the patient with either cell saver or cardiotomy suction. Blood samples were taken before and after filtration in the cardiotomy suction group or cell saver processing in the cell saver group. After centrifuging samples, fat content was graded on a scale of 0-3 by a blinded independent observer. Fat content was also quantified by weight. RESULTS: Compared with cardiotomy suction, cell saver removed significantly more fat from shed blood. Median fat grading after cell saver was 0 (0-1) compared with 1 (1-2) for cardiotomy suction (P=0.0001). Percentage reduction in fat weight achieved by cell saver or cardiotomy suction was 87% compared to 45% (P=0.007). There was no difference in the post-operative use of blood or blood products, haemoglobin, or bleeding between the two groups. CONCLUSION: Use of cell saver results in less fat being recycled during cardiopulmonary bypass.

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PubMed2002

Evaluating routine diuretics after coronary surgery: a prospective randomized controlled trial.

BACKGROUND: Routine diuretic administration after cardiopulmonary bypass is common despite the lack of evidence for its benefit. We performed a prospective study to evaluate if diuretics assist in weight loss or alter clinical outcome. METHODS: Seventy-nine patients undergoing primary elective coronary bypass surgery were randomized to either diuretic (fusemide and amiloride) or placebo (lactose) postoperatively until preoperative weight was achieved or for 5 days in total. Proportions were compared with chi2 or Fisher's exact test. RESULTS: Forty patients were randomized to diuretics and 39 to placebo. By day 5, 97% of patients (37 of 38) still in the diuretic arm, and 74% of patients (29 of 39) in the placebo arm, achieved preoperative weight (p = 0.02). There were no differences in clinical outcomes. CONCLUSIONS: Routine diuretics promote an earlier diuresis but no clinical benefits are apparent in low risk patients with normal renal function. Clinicians should reconsider routine diuretic prescription in this setting.

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PubMedDate not supplied

A comparison of 250 and 500 mL of terminal warm blood cardioplegia after global myocardial ischemia: a prospective randomized study.

BACKGROUND: Controlled reperfusion with terminal warm blood cardioplegia (TWBC) improves myocardial performance after global ischemia. However, the optimum volume required is unknown. METHODS: Fifty patients undergoing elective coronary artery bypass graft surgery were prospectively randomized to receive either 250 or 500 mL of TWBC. During TWBC delivery, and for 10 minutes after cross-clamp removal, samples were taken from the aorta and coronary sinus to measure the hydrogen ion, lactate, and oxygen content. RESULTS: At the end of TWBC delivery, the 500 mL group had significantly less hydrogen ion washout (p = 0.006) compared with the 250 mL group. Also, more hydrogen ions (p = 0.02) and lactate (p = 0.02) had been washed out during the entire period of TWBC delivery in the 500 mL group compared with the 250 mL, indicating better metabolic recovery. By 4 minutes after aortic cross-clamp removal, hydrogen ion and lactate washout, as well as oxygen extraction was similar in the two groups. However, the time to return to regular mechanical activity was prolonged in the 500 mL group, 5.8 (3) versus 4.6 (3) minutes in the 250 mL group (p = 0.05). Though there was no difference in postoperative Troponin T levels, eight patients in the 500 mL group versus four in the 250 mL group required ionotropic support (p = 0.1). CONCLUSIONS: A total of 500 mL of hotshot achieves a better metabolic state after hotshot delivery. However, there is no clinical benefit or improvement in the postoperative Troponin T release suggesting that in a short ischemic time, 500 mL TWCB has a limited clinical benefit.

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