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Biomedical subjects

O Oba

Publications and source records attributed to O Oba.

15 recordsLinked to original sources
PubMed2001

Risk factors reducing blood transfusion requirements in pediatric open heart surgery after introduction of vacuum assisted circuits.

OBJECTIVES: Open heart surgery without homologous blood transfusion remains difficult in children. The introduction of vacuum-assisted cardiopulmonary bypass circuits to reduce priming volume for pediatric patients has improved the percentage of transfusion-free operations. We retrospectively analyzed blood transfusion risk factors to further reduce blood transfusion requirements after vacuum-assisted circuit introduction. METHODS: From March 1995 to June 1996, 49 patients weighing between 5 and 20 kg underwent cardiac surgery with cardiopulmonary bypass at our institution, excluding hospital deaths. We retrospectively analyzed risk factors influencing blood use in 37 patients with no blood priming in cardiopulmonary bypass after introducing a vacuum-assisted system. Factors selected for univariate analysis were age, body weight, cyanosis, preoperative Hb, operation time, cardiopulmonary bypass time, aortic cross-clamping time, and intraoperative and postoperative bleeding volume. Correlation between total bleeding volume/body weight and cardiopulmonary bypass time was studied by regression analysis. RESULTS: As risk factors, univariate analysis identified cyanotic disease, longer operation time (> 210 minutes), longer cardiopulmonary bypass time (> 90 minutes), longer aortic cross-clamping time (> 45 minutes), greater intraoperative bleeding volume/body weight (> 4 ml/kg), and greater postoperative bleeding volume/body weight (> 15 ml/kg). Regression analysis showed a significant positive correlation between total bleeding volume/body weight and cardiopulmonary bypass time. CONCLUSIONS: Cyanotic disease and long bypass time are risk factors in reducing blood transfusion requirements in pediatric open heart surgery after introduction of vacuum-assisted circuits. Further efforts are needed, however, to reduce blood transfusion requirements, particularly in these children.

Blood Loss, Surgical↗
PubMed2001

Usefulness of vacuum-assisted cardiopulmonary bypass circuit for pediatric open-heart surgery in reducing homologous blood transfusion.

OBJECTIVE: Open-heart surgery without homologous blood transfusion is still difficult in children because priming volume in cardiopulmonary bypass circuit results in extreme hemodilution. Vacuum-assisted cardiopulmonary bypass circuit has the benefit of improving venous return and results in lowering priming volume. We introduced vacuum-assisted cardiopulmonary bypass circuit in order to reduce priming volume for pediatric patients in March 1995. A retrospective study was made on the efficacy of vacuum-assisted circuit for pediatric open-heart surgery in reducing homologous blood transfusion. METHODS: Patients weighing from 5 to 20 kg who underwent surgery between January 1991 and June 1996 were divided into two groups, group A comprised 128 patients before introduction of this circuit and group B comprised 49 patients after introduction, and their clinical course was compared. Vacuum-assisted circuit was used in 27 patients of group B. RESULTS: The percentage of transfusion-free operations was significantly higher in group B than in group A (33.6% in group A vs. 53.1% in group B, P = 0.014), and particularly this percentage in patients weighing less than 10 kg significantly increased (0% in group A vs. 42.9% in group B, P < 0.01). The amount of homologous blood transfusion was significantly lower in group B than in group A (374 +/- 362 ml in group A and 212 +/- 287 ml in group B, P < 0.01). The rate of complications and the duration of respiratory support did not differ between the two groups. The duration of hospital stay was lower in group B than in group A. CONCLUSIONS: The findings of this study indicate that vacuum-assisted circuit is useful for pediatric open-heart surgery in reducing homologous blood transfusion.

Blood Transfusion↗
PubMed2000

[Double valve replacement without blood transfusion in a case complicated with liver cirrhosis and pancytopenia].

A 63-year-old woman complicated with liver cirrhosis and pancytopenia was admitted for aortic and mitral valve replacement. As laboratory findings at time of admission showed pancytopenia with Hb of 7.3 g/dl, WBC of 2,200/mm3, and platelet of 6.2 x 10(4)/mm3, splenectomy was first conducted and the blood cells and platelet increased in number. At 27 days after splenectomy, double vale replacement was performed without blood transfusion and her postoperative course was unevenfull. It is considered that preoperative splenectomy is useful in management of patients complicated with hypersplenism and pancytopenia.

Aortic Valve↗
PubMed1997

[Results of cardiac operation and thoracic aortic operation in patients aged 75 years or older].

A total of 121 patients aged 75 years or older underwent cardiac operation or thoracic aortic operation at our hospital between 1988 and February 1997. They were composed of 74 cases of ischemic heart disease, 22 cases of valvular disease, 1 case of myxoma, and 24 cases of thoracic aortic disease. Operative mortality rate was 13.5% in ischemic heart disease, 4.2% in valvular disease and myxoma, and 25% in thoracic aortic disease. In ischemic heart disease, the operative mortality rate was especially high in emergency operation for acute myocardial infarction. In thoracic aortic operation, further improvement should be made with regard to preoperative and intraoperative management.

Age Factors↗
PubMed1997

[Study on risk factors and late results of coronary artery bypass grafting for acute myocardial infarction].

Study was made on the operative results, risk factors, and late results of coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) conducted at our hospital. The subjects of the present study were 70 cases of AMI who underwent CABG during a period of five years from January 1991 to December 1995. They were composed of 61 males and 9 females whose mean age was 61.9 years. LMT disease was observed in 13 cases and preoperative shock in 18 cases. The mean aortic cross-clamp time was 64 minutes with the mean extracorporeal circulation time being 134 minutes and the mean number of grafts being 2.5. The mean preoperative-postoperative peak creatine kinase was 4479 IU/L. The number of operative deaths was 14 with a mortality rate of 20%. When compared with elective cases of CABG conducted during the same period with a mortality rate of 2.7%, the operative result of AMI was poor. The mortality rate by risk factor was 40% for age of 70 years or more, 46.2% for complication of LMT disease, 52.9% for preoperative shock, 58.3% for preoperative C.I. of less than 2.0, 80% for postoperative C.I. of less than 2.0, 28.2% for conduct of postoperative circulatory support, and 42.1% for peak creatine kinase of 5000 IU/L or more. Aortic cross-clamp time and reperfusion time (interval from onset of AMI to aortic declamp) were found not to be risk factors. Late death accounted for 5 cases including one case of cardiac death due to suspected AMI. Survival rate excluding operative deaths and hospital deaths was 98% in one year and 83.9% in five years. When compared to non cardiacevent cases, the survival rate of positive cardiac event cases was significantly poor. The operative results of severe myocardial ischemia cases represented by cases of complication of LMT disease were poor and it is considered that improvement of intraoperative myocardial protection and aggressive use of postoperative circulatory support are necessary in the future. The survival cases of those who could endure surgery was comparatively satisfactory, but when cardiac event developed, prognosis was poor and thus more rigid follow-up is considered to be necessary.

Age Factors↗
PubMed1994

[Cardiac operations in nine patients aged 80 years or older].

Nine patients aged 80 years or older underwent cardiac operations with cardiopulmonary bypass. Seven patients underwent coronary artery bypass surgery, one modified Bentall's operation and another patch closure of ventricular septal perforation. One patient died soon after operation (11 POD) and operative mortality was 11%. One died 7 months after operation because of rupture of dissecting thoracic aortic aneurysm. Seven patients are still alive within physical status of New York Heart Association Classes I or II. We conclude that cardiac operations should not be excluded in octogenarians because of their chronological age alone.

Age Factors↗
PubMed1994

[Re-operation long after the Rastelli's procedures].

Secondary reconstructive operations were performed in six patients, who received Rastelli's procedure in their childhood. Six patients consisted of three tetralogy of Fallot with pulmonary atresia, two double outlet right ventricle, and one truncus arteriosus. The reoperations were undergone five to eleven years after the first operation. One patient received a replacement of a old valved conduit with a new larger one because of relative stenosis. The other five patients received reconstructive operations in which an old valved conduit was removed and a new conduit was constructed using the conduit bed as the posterior wall and a patch of xenograft pericardium. All operations performed successfully with no hospital or late cardiac death.

Adolescent↗
PubMed1994

[A study of pacemaker implantation to cases performed valve surgery].

For 13 years between 1980 and 1992, 23 patients needed pacemaker (PM) implantation because of bradyarrhythmia, 21 of atrial fibrillation and two of complete A-V block, after valve surgery. Five of 88 survivors (5.7%) after OMC, 11 of 227 (4.8%) after MVR, one of 169 (0.6%) after AVR, five of 67 (7.4%) after MVR + AVR and one of 15 (6.7%) after TVR underwent PM implantation in postoperative period. Two cases who had heart failure was implanted PM in early postoperative period. In late period, the mean duration between previous valve surgery and PM implantation was 6.4 years in 12 cases after initial valve surgery and 2.3 years in nine after second valve surgery. Postoperative course after PM implantation was almost good, but one case was died due to critical arrhythmia. And one case underwent re-MVR because of mitral bioprosthesis dysfunction and one, without anticoagulant after OMC, was complicated cerebral infarction.

Adult↗
PubMed1993

[Surgical treatment of the patients with pulmonary atresia, ventricular septal defect associated with major aorto-pulmonary collateral arteries--a report of two cases].

Two patients undergoing corrective operation for pulmonary atresia with ventricular septal defect associated with major aortopulmonary collateral arteries (MAPCAs) were reported. Both patients underwent staged surgical repair, first stage: unifocalization, and second stage: Rastelli type operation. Case 1 was a 13-year-old female who had a confluent central pulmonary artery and 1 MAPCA, unifocalized at 10 years of age. After the corrective operation, the ratio between peak right ventricular and peak left ventricular pressure (pRV/LV) was 0.5 and she followed a satisfactory post-operative course. Case 2 was a 11-year-old female who had a severe hypoplastic central pulmonary artery (3 mm in diameter) and 3 MAPCAs, and she underwent unifocalization twice. After the corrective operation, pRV/LV was 0.65 and her postoperative course was also satisfactory.

Adolescent↗
PubMed1993

[Cerebral protection during aortic arch replacement: usefulness of continuous O2 saturation monitoring of internal jugular bulb to optimize cerebral perfusion].

How to optimize cerebral perfusion pressure and flow during selective extracorporeal circulation is a crucial problem for cerebral protection in surgical repair of aortic arch aneurysm. Among 47 cases of aortic arch replacement between 1980 and 1992, extracorporeal circulation (ECC) for the first 17 cases [group-1] were hypothermic ECC with selective cerebral perfusion (SCP) and 8 cases [group-2] with hypothermic ECC with hypothermic cardiac arrest. For the latest 16 cases [group-3] we introduced continuous O2 saturation monitoring by oximetry catheter placed in internal jugular bulb (SIJVO2) and maintained SIJVO2 value above 90% to effectively adjust pump flow to optimize cerebral perfusion pressure and flow for cerebral protection. We have retrospectively compared the effectiveness of SIJVO2 monitoring among these three groups. The mortality was 35% (6 cases: group-1), 37% (3 cases: group-2) and 6% (1 case: group-3) respectively. Cerebral dysfunction which were diagnosed in immediate postoperative period were 23% (4 cases: group-1), 0% (0 case: group-2) and 6% (1 case: group-3) respectively. We conclude continuous monitoring of SIJVO2 during selective ECC in aortic arch replacement is useful to optimize cerebral perfusion pressure and flow thereby reducing postoperative cerebral damage by selective ECC.

Adult↗