止血环酸在心肺转流术中对凝血功能的影响

目的 应用sonoclot分析仪(SCT)观察止血环酸在心脏手术中的血液保护效果。方法36例心脏手术患者分成工组(抑肽酶,n=12)、Ⅱ组(止血环酸,n=12)和Ⅲ组(非用药组,n=12)。Ⅰ、Ⅱ组在心肺转流(CPB)下完成心脏手术,Ⅲ组则为非CPB下的冠脉搭桥手术。应用SCT观察切皮前和鱼精蛋白中和肝素后的凝血和血小板(Plt)功能的变化。结果 sonACT在T_1时点Ⅲ组为(123.21±18.58)s,明显高于Ⅰ组的(110.36±24.72)s和Ⅱ组的(106.09±13.91)s(P均<0.05);纤维蛋白凝集率(clot rate)、Plt功能在T_1与T_2时点三组之间均无显著差异。Plt在T_2时点Ⅲ组则明显高于Ⅰ、Ⅱ组。Ⅰ、Ⅱ组在T_2时点的Plt较T_1下降非常显著(P<0.01),Ⅲ组则无明显改变。结论 止血环酸对CPB下心脏手术患者凝血与Plt功能的影响与抑肽酶相似,非CPB下冠状动脉搭桥术对血液系统的影响明显减轻。     

活体肝移植术中血流动力学和凝血功能的变化

目的 观察活体肝移植术中血流动力学及凝血功能的变化.方法 92例晚期肝病患者接受活体肝移植术,观察并记录患者人手术室(T0)、麻醉后(T1)、无肝前期(T2)、无肝期末(T3)、新肝期5 min(T4)、120 min(T5)时的BP、HR、CVP、心输出量(CO)、肺动脉压(MPAP)的变化及pH值、碱剩余(BE)、血糖(Glu)、乳酸(Lac)浓度,并监测凝血功能.结果 与T0时比较,T1～T5时SBP、DBP明显下降(P＜0.05),T3、T4时HR明显增快(P＜0.01).与前一时点比较,T3时CVP和CO下降(P＜0.05或P＜0.01).与T0时比较,T2～L时pH、BE均下降(P＜0.01),T4、T5 Glu、Lac明显升高(P＜0.01).与T1时比较,T4激活凝血时间(ACT)明显延长,凝集速率(CR)及血小板功能(PF)明显下降(P＜0.05或P＜0.01),T5时凝血功能逐渐恢复.结论 活体肝移植术中血流动力学、内环境及凝血在无肝期及新肝期有较大变化,术中加强各生理指标的监测,及时纠正循环和代谢紊乱,调整凝血是保证肝移植手术成功的关键.     

七氟醚对冠状动脉旁路移植术患者心肺转流后右心室功能的影响

目的评价七氟醚对冠状动脉旁路移植术(CABG)患者心肺转流(CPB)后右心室收缩功能的影响。方法选择择期CPB下行CABG的冠心病患者18例,男13例,女5例,年龄50~80岁,ASAⅡ或Ⅲ级。麻醉维持采用静脉麻醉,于CPB后15min开始在静脉麻醉基础上持续吸入七氟醚1 MAC 60min。记录麻醉诱导后锯胸骨前(T1)、停CPB后15min开始吸入七氟醚前(T2)、停CPB后吸入七氟醚1 MAC 30min(T3)、60min(T4)时的HR、MAP、CVP、心输出量(CO)、外周血管阻力(SVR)和三尖瓣环收缩期位移(TAPSE)、三尖瓣瓣环收缩期速度(TAPSV)。结果与T1时比较,T2时CO明显升高(P0.05);与T2时比较,T3、T4时CO明显下降(P0.05或P0.01)。与T1时比较,T2时TAPSE、TAPSV明显增大(P0.05或P0.01);与T2时比较,T3、T4时TAPSE、TAPSV明显减小(P0.05)。结论择期CPB下行CABG的患者,停CPB后吸入七氟醚1 MAC可降低右心室收缩功能,但仍在临床正常范围。     

复方醋酸钠在心肺转流心脏瓣膜置换术中对血乳酸和血糖的影响

目的 观察复方醋酸钠溶液在心肺转流(CPB)心脏瓣膜置换术中对血乳酸(Lac)、血糖(Glu)及血钾(K+)浓度的影响.方法 择期行CPB心脏瓣膜置换术患者40例,随机均分为复方乳酸钠组(R组)和复方醋酸钠组(L组).于CPB开始前(T0)、CPB开始后15 min(T1)、升主动脉开放前5 min(T2)、CPB结束前5 min(T3)和关胸后(T4)抽取动脉血或CPB机管路动脉端血液,检测Lac、Glu、K+浓度.结果 L组Lac浓度在T1～T4时均显著低于R组(P＜0.05);L组Glu浓度仅在T1时点明显高于R组(P＜0.05);两组各时点血K+差异无统计学意义.结论 心脏瓣膜置换术中,用复方醋酸钠作CPB晶体稀释液可降低术中Lac浓度的升高.     

丙泊酚和依托咪酯对心脏瓣膜置换术患者肌钙蛋白I和超敏C反应蛋白的影响

目的 比较等效剂量丙泊酚和依托咪酯乳剂对心肺转流( CPB)心脏瓣膜置换术患者血清心肌肌钙蛋白I (cTnI)和超敏C反应蛋白(hsCRP)的影响.方法 择期心脏瓣膜置换术患者60例,随机均分为两组:丙泊酚组(P组)术中静脉持续输注丙泊酚3～5 mg·kg-1· h-1,依托咪酯乳剂组(E组)持续输注依托咪酯0.3～0.6 mg·kg-1·h-1维持麻醉.分别于麻醉诱导前(T0)、CPB前(T1)、主动脉开放即刻(T2)、主动脉开放后30 min(T3)、停CPB后4 h(T4)、24 h(T5)采取静脉血,测定血清cTnI和血浆hsCRP浓度.结果 与T0时比较,T2～T5时两组血清cTnI浓度均显著升高(P＜0.01),且E组显著高于P组(P＜0.01);T1～T5时E组血浆hsCRP浓度显著升高(P＜0.01),且明显高于P组(P＜0.01),而P组仅在T4、T5时显著升高(P＜0.01).结论 等效剂量丙泊酚用于CPB心脏瓣膜置换术麻醉维持的心肌保护作用优于依托咪酯乳剂.     

0.33％等比重罗哌卡因蛛网膜下腔阻滞在高龄半髋关节置换术中的应用研究

目的 评价0.33％等比重罗哌卡因蛛网膜下腔阻滞在高龄半髋关节置换术中应用的安全性和有效性. 方法 年龄≥70岁,ASA分级Ⅱ、Ⅲ级,行半髋关节置换术的患者150例,按随机数字表法分为A组、B组、C组(每组50例).所有患者均采用健侧卧位,穿刺间隙为L3～L4椎间隙,用脑脊液将1％盐酸罗哌卡因注射液稀释成0.33％(1 ml罗哌卡因+2 ml脑脊液),A组、B组、C组分别给予2.2、2.0、1.8 ml.于麻醉前(T0),蛛网膜下腔注药后5 min (T1)、10 min(T2)和15 min(T3),手术开始时(T4),手术开始后30 min(T5),术毕(T6)时点,记录MAP、HR和感觉阻滞平面高度,并记录麻醉诱导时间、手术时间、术中出血量、尿量和输液量以及术中、术后相关并发症. 结果 蛛网膜下腔阻滞有效率和阻滞效果A组明显优于B组、C组,且B组优于C组(P＜0.05).麻醉诱导时间A组[(15.6±1.4) min]明显短于B组[(19.5±6.3)min]、C组[(26.6±7.1) min],且B组短于C组(P＜0.05).HR在A组T1～T6时[(80±12)、(80±11)、(78±10)、(77±10)、(77±10)、(77±10)次/min]和B组T1～T2时[(77±8)、(77±7)次/min]较各组To时[(71±11)、(73±9)次/min]明显增快(P＜0.05);MAP在A组T1、T2时[(96±8)、(98±8) mmHg(1 mmHg=0.133 kPa)]、B和C组T4～T6时[(100±8)、(100±8)、(100±8) mmHg和(96±8)、(98±7)、(99±8) mmHg]较各组To时[(104±8)、(104±8)、(103±8) mmHg]均明显降低(P＜0.05),且C组T4～T6时较T3时也明显降低(P＜0.05).T1～T3时A组感觉阻滞平面明显高于B组和C组,且B组高于C组(P＜0.05);在T4～T6时A组和B组明显高于C组(P＜0.05);与T3比较,A组感觉阻滞平面在T6时明显降低(P＜0.05);B组、C组感觉阻滞平面在T4～T6时明显升高(P＜0.05).术中低血压和恶心呕吐的发生率A组、B组均明显低于C组(P＜0.05),而A组和B组比较,差异均无统计学意义(P＞o.05). 结论 0.33％等比重罗哌卡因蛛网膜下腔阻滞应用于高龄半髋关节置换术中具有安全性和有效性.     

雷米芬太尼预处理对冠状动脉旁路移植术患者S-100β蛋白的影响

目的 探讨雷米芬太尼预处理心肺转流(CPB)辅助下行冠状动脉旁路移植术(CABG)患者血浆S-100β蛋白的影响.方法 选择择期行CPB下CABG患者40例.随机分为雷米芬太尼预处理组(R组)30例和对照组(C组)10例.R组又分为R1、R2和R3三个亚组,每组10例.麻醉诱导后30 min,分别以雷米芬太尼0.6μg·kg-1·min-1(R1组)、1.2μg·kg-1·min-1(R2组)和1.8μg·kg-1·min-1(R3组)持续泵注5 min,间隔5 min,如此重复上述给药方法3次后开始手术;C组以生理盐水代替雷米芬太尼.于诱导前(T0)、CPB前(T1)、CPB后30 min(T2)、CPB结束时(T3)采集颈内静脉球血测定血浆S-1001β蛋白浓度.并进行术前、术后24 h智能精神状态量表(MMSE)评分.结果 MMSE评分R3组术前与术后24 h差值明显小于其他三组(P＜0.05);四组S-100β蛋白浓度在T2和T3时均明显高于T0和T1时(P＜0.01).R3组S-100β蛋白浓度在T2和T3时明显低于C组(P＜0.05).结论 雷米芬太尼1.8 μg·kg-1·min1预处理具有脑保护作用.     

心肺转流后鱼精蛋白经左房给药的可行性

目的 探讨心肺转流(CPB)后经左心房给鱼精蛋白的可行性.方法 36例心内直视手术患者按鱼精蛋白给药途径随机分为三组:A组中心静脉给药、B组左房给药、C组主动脉根部给药,每组12例.CPB结束后,三组以1.5倍肝素钠的量注射鱼精蛋白,给药速度1 mg·kg-1·min-1.记录鱼精蛋白给药前(T0)和给药后1 min(T1)、3 min(T2)、5 min(T3)、10 min(T4)的MAP、CVP、气道阻力(AWR),取右房血5 ml检测血栓素B2(TXB2,TXA2稳定代谢产物)和组胺的浓度,在T3时测活化全血凝固时间(ACT).结果 与T0时比较,T1～T3时A组MAP明显下降(P＜0.05或P＜0.01),且低于B、C组(P＜0.05或P＜0.01);T1～T3时A组CVP、AWR升高,且T2、T3时A组明显高于B、C组(P＜0.05);T1时A组TXB2和组胺浓度升高,且持续至T4(P＜0.05或P＜0.01);B、C组TXB2升高延迟(P＜0.05或P＜0.01),且相应时点升高的程度小于A组(P＜0.05或P＜0.01).结论 与经主动脉根部给药一样,经左房给鱼精蛋白也可以明显减轻其对血流动力学和肺通气的影响.     

雷米芬太尼后处理对心肺转流诱导犬心肌损伤和炎症因子的影响

目的 探讨雷米芬太尼后处理对心肺转流(CPB)诱导犬心肌损伤和炎症因子的影响.方法 健康成年雄性犬12只,随机均分为雷米芬太尼组(R组)和对照组(C组).两组动物经麻醉和开胸后,建立CPB心肌缺血-再灌注模型,阻断升主动脉60 min.R组于主动脉阻断55 min时自主动脉根部随温血灌注液持续输注雷米芬太尼5 min,速度为4μg·kg-1·min-1,灌注液输注速率2 ml·kg-1·min-1持续5 min.C组于相同时点行温血再灌注,灌注液输注速率同R组.分别于CPB前5 min(T0)、阻断升主动脉后30 min(T1)、开放升主动脉后5 min(T2)、停CPB 30 min(T3)和停CPB 2 h(T4)采集股动脉血,检测心肌肌钙蛋白I(cTnI)的浓度和血浆肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)、IL-8.记录主动脉开放后心脏自动复跳情况,电镜下观察心肌组织超微结构改变.结果 与T0时比较,两组cTnI、TNF-α在CPB后各时点均明显升高(P＜0.05或P＜0.01),升主动脉开放后各时点IL-6、IL-8均明显升高(P＜0.01).R组升主动脉开放后各时点cTnI、TNF-α、IL-6、IL-8均明显低于C组(P＜0.01).R组心肌组织结构损伤程度轻于C组.结论 雷米芬太尼后处理可抑制犬CPB诱导促炎细胞因子的释放,减轻心肌再灌注损伤.     

声门上喷射通气在无痛纤维支气管镜检查中的应用

目的 通过与改良普通喉罩比较,评价声门上喷射通气在无痛纤维支气管镜检查中应用的安全性和可行性.方法 选择行无痛纤维支气管镜检查的患者80例,年龄22～68岁,采用随机数字表法分为两组(每组40例):声门上喷射通气组(J组)和改良普通喉罩通气组(L组).记录两组患者一次放置成功率、成功放置时间、检查时间、检查成功率、检查暴露情况以及麻醉前(T0)、插入喉罩(或鼻咽通气道)即刻(T1)、纤维支气管镜通过声门时(T2)、纤维支气管镜通过声门后3 min(T3)及检查结束时(T4)的MAP、HR、SpO2和PETO2,并记录其并发症.结果 一次性放置成功率和检查优良率J组(100％,97.5％)明显高于L组(81.1％,81.1％)(P＜0.05);成功放置时间和检查时间J组[(10.8±2.6)s,(13±4) min]明显短于L组[(23.2±12.7)s,(23±10) min](P＜0.05);J组患者满意度明显优于L组(P＜0.05),但操作者满意度组间比较差异无统计学意义(P＞0.05);咽痛发生率L组(81.1％)明显高于J组(12.5％)(P＜0.05);其他比较差异均无统计学意义(P＞0.05).结论 声门上喷射通气在无痛纤维支气管镜检查中应用是安全可行性的,且并发症少.     

Cardiopulmonary bypass recommendations in adults: the northern New England experience

Using a regional cardiopulmonary bypass (CPB) registry, we compared the practice of CPB at eight northern New England institutions to recently published recommendations. We examined CPB practice among 3597 adult patients undergoing isolated coronary artery bypass grafting surgery from January 2004 to June 2005. Registry variables were used to compare regional CPB practice to recommendations on topics of neurologic protection (pH management, avoidance of hyperthermia, minimizing return of pericardial suction blood, aortic assessment, arterial line filtration), maintenance of euglycemia, reduction of hemodilution, and attenuation of the inflammatory response. We report overall regional practice (regional minimum, maximum). All centers used alpha-stat pH management and arterial line filters. Avoidance of hyperthermia (temperature < 37degrees C) was achieved during 23.4% of procedures (regional minimum, 1.5%; maximum, 83.2%). Minimizing return of pericardial suction blood was achieved in 23.7% of cases (0.7%, 93.6%). Aortic assessment was performed during 45.7% of procedures (1.3%, 98.9%). Maintenance of euglycemia (< 200 mg/dL) was accomplished in 82.7% (57.1%, 97.9%) of cases. Hemodilution (hematocrit < 23% on CPB) was lower for men 32.4% (20.6%, 52.3%) than women 77.9% (64.7% 88.9%). Men were less likely to receive red blood cell transfusions in the operating room (11.0%; 1.8%, 20.9%) than women (54.6%; 30.1%, 70.6%). In an effort to attenuate the inflammatory response, surface coated circuits were used in 83.3% of procedures (8.8%, 100%). During this time, gaps existed between regional CPB practice and recently published recommendations. We continue to prospectively measure CPB practice relating to these recommendations to monitor and improve the care provided to our patients.     

Long-term evaluation of EC-IC bypass patency

Summary The EC-IC Bypass Study Group could not detect any benefit from surgery compared to medical management in the prevention of stroke in 1985 [15]. During the past years surgical revascularization was re-evaluated and considered as an appropriate treatment for a small subgroup of patients with recurrent focal cerebral ischaemia and impaired haemodynamics. This retrospective study examines the long-term benefit and patency rate of bypass.We present a follow-up of 5.6 years of 47 patients, all of whom underwent byupass surgery after 1985. Forty patients suffered recurring transient ischaemic attacks due to uni- or bilateral internal carotid artery occlusion. Examination included neurologic status, TCD with CO₂ or Diamox challenge, angiography, CT and SPECT scans.Neurological improvement was seen in 23% of patients with better results after early surgery, a worsening in 22% suffering further ischaemic events on a postoperative average of 2.8 years. Patency rate for vein graft material was 50%, for the STA-MCA procedure 91%. Occlusion of the vein graft occurred on an average after 1.4 years, other anastomosis after 2.7 years.We conclude that only few patients derived long-term benefit from EC-IC bypasses. Functioning of the bypass worsens over time, suggesting a role for surgery predominantly in the first year of ischaemic events due to insufficient collateral supply. Actual indications for bypass surgery may be patients with failure of maximal medical therapy and progressive ischaemia and haemodynamic compromise.     

Perforated marginal ulcer after gastric bypass for obesity: a systematic review

Marginal ulcers are a recognized complication of gastric bypass procedures for obesity. Perforated marginal ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. PubMed, Google Scholar, and Embase databases were searched to identify all studies on PMUs after gastric bypass procedures. A total of 610 patients were identified from 26 articles. The mean age was 39.8±2.59 years, and females represented most of the cohort (67%). The mean body mass index was 43.2±5.67 kg/m². Most of the patients had undergone a Roux-en-Y gastric bypass (98%). The time gap between the primary bariatric surgery and the diagnosis of PMU was 27.5±8.56 months. The most common presenting symptom was abdominal pain (99.5%) and a computed tomography scan was the diagnostic modality used in 72% of the patients. Only 15% of patients were on prophylactic proton pump inhibitors or H2 blockers at the time of perforation, and 41% of patients were smoking at the time. Twenty-three percent of patients were on nonsteroidal anti-inflammatory drugs. Laparoscopic omental patch repair of the perforation (59%) was the most used technique; 18% of patients underwent open surgery, and 20% were managed non-surgically. Thirty-day mortality was 0.97%; it was 1.21% (n=5) and 0% (n=0) in those who were managed surgically and nonsurgically, respectively. Ulcers recurred in 5% of patients. In conclusion, PMU is a surgical emergency after gastric bypass that can result in significant morbidity and even mortality. This is the first systematic review in scientific literature characterizing this condition.     

Early results of off-pump coronary artery bypass

Objective: The purpose of this study is to compare the operative results of off-pump coronary artery bypass (OPCAB) and on-pump (conventional) coronary artery bypass (CCAB), to clarify qualitative problems and whether OPCAB is less invasive or not. Methods: OPCAB was consecutively performed in 63 patients and CCAB in 63 patients between July 1998 and December 2003. Results: The mean number of bypass grafts was 2.43 ±0.82 in the OPCAB group and 2.70±0.71 in the CCAB group (p=0.096). In-hospital mortality was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of perioperative myocardial infarction was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of postoperative major complications was significantly lower in the OPCAB group than in the CCAB group (OPCAB group=4 complications, CCAB group=13 complications). Cerebrovascular accidents occurred in 1.6% of patients in both groups. The incidence of sternal infection or mediastinitis was 0% in the OPCAB group and 3.2% in the CCAB group. The early patency rate of graft was 94.0% in the OPCAB group and 92.8% in the CCAB group, and was not significantly different (p=0.822). Conclusion: Operative mortality and major complications after surgery in OPCAB were lower than that in CCAB. The early patency rate in OPCAB was as good as that in CCAB. It is considered that OPCAB is less invasive and the quality of bypass in OPCAB is as good as that in CCAB.     

Combined aortobifemoral and femoropopliteal bypass in the management of patients with extensive atherosclerosis

Certain patients have atherosclerosis in both aortoillac and femoropopliteal segments of the arterial tree and thus do not have a good result from reconstruction of the aortoiliac segment. No method has been developed to identify these patients and we do not know whether, by combining a femoropopliteal bypass with an aortobifemoral bypass, the results can be improved. We present a series of 153 patients with severe multilevel occlusive disease treated by simultaneous reconstruction and followed for up to 6.5 years. The cumulative patency of the femoropopliteal bypasses was 80% at four years. Functional and symptomatic improvement was excellent, and operative mortality was low when one considers the age and poor general condition of the patients.     

Unilateral iliac artery occlusive disease: A randomized multicenter trial examining direct revascularization versus crossover bypass

This randomized trial compared the patency of direct unilateral aorto- or iliofemoral prosthetic bypass with that of crossover femorofemoral or iliofemoral bypass in unilateral atheromatous occlusive disease of the iliac artery. Between May 1986 and March 1991, 143 patients were enrolled in this study (74 crossover and 69 direct revascularizations). Cardiovascular risk factors, preoperative symptoms, and atheromatous lesions were similar in both groups. Patients were followed by Duplex scanning with systolic pressure index measurements. Routine digital subtraction arteriograms were obtained postoperatively and separately, when hemodynamic anomalies developed. Mean follow-up was 22 months. One patient with direct revascularization died postoperatively. Primary patency of direct revascularizations was 89.8% at 48 months compared with 52% for crossover bypass. This difference was statistically significant. Secondary patency of direct and crossover revascularization at 48 months was 92.9% and 93.6%, respectively (not significant). Even though crossover bypasses seem attractive because of their technical simplicity and low morbidity, our results suggest that direct revascularizations are preferable in the young patient with no major operative risks, while crossover bypasses remain indicated in patients at risk.Presented at the Annual Meeting of the Société de Chirurgie Vasculaire de Langue Française, June 20–21 1991, Marseille, France.     

Infrageniculate thin-walled PTFE bypass: Preliminary study of 53 cases

Between May 1, 1983 and May 1, 1985, 53 patients whose mean age was 75 years, and who presented with rest pain or ischemic changes had infrageniculate insertion of femoropopliteal or femorotibial thin-walled polytetrafluoroethylene (PTFE-TW) bypasses. Occlusive atherosclerotic disease was present in all patients. Postoperative follow-up ranged from 6 to 30 months. One patient died in the immediate post-operative period whereas 15 others died later during follow-up. There was one case of prosthetic sepsis. No anastomotic aneurysms occurred. Actuarial analysis of overall patency rates in significant population samples showed that 88% and 68% of bypasses were functional at one month and two years, respectively. The overall rate of early amputation was 17%. Overall limb salvage was 67% at 30 months. In patients over 75, 85% of bypasses were patent at one year whereas life expectancy for one year in this same group of patients was 49%. Although this is a preliminary study, results obtained with this new material suggest that an average gain of 20% in patency rates can be expected compared to those recorded with standard PTFE prostheses. The PTFE-TW vascular prosthesis may be the material of first choice for the geriatric patient in order to promote early hospital discharge and return to the home environment. Even though long-term patency rates of venous grafts are better, we believe that the use of PTFE-TW prostheses in elderly patients with limited life expectancy may be preferred.     

Effect of Location and Speed of Diagnosis on Anastomotic Leak Outcomes in 3828 Gastric Bypass Cases

Introduction Leaks after Roux-en-Y gastric bypass are a major cause of mortality. This study attempts to define the relationship between the leak site, time from surgery to detection, and outcome. Methods Retrospective review of 3,828 gastric bypass procedures. Results Of the leaks (3.9% overall), 60/2,337 (2.6%) occurred after open gastric bypass, 57/1,080 (5.2%) after laparoscopic gastric bypass, and 33/411 (8.0%) after revisions. Overall leak-related mortality after Roux-en-Y gastric bypass was 0.6% (22/3,828). Mortality rate from gastrojejunostomy leaks (38 in the open gastric bypass, and 43 in the laparoscopic) was higher in the open group than the laparoscopic group (18.4 vs 2.3%, p = 0.015). Median time of detection for a gastrojejunostomy leak in the open group was longer than in the laparoscopic group (3 vs 1 days, Wilcoxon score p < 0.001). Jejunojejunostomy (JJ) leak was associated with a 40% mortality rate. Initial upper gastrointestinal series did not detect 9/10 jejunojejunostomy leaks. Median detection time was longer in the jejunojejunostomy leak group than the gastrojejunostomy leak group (4 vs 2 days, p = 0.037). Discussion Leak mortality and time of detection was higher after open gastric bypass than laparoscopic gastric bypass. GBP patients with normal upper gastrointestinal (UGI) studies may harbor leaks, especially at the JJ or excluded stomach. Normal UGI findings should not delay therapy if clinical signs suggest a leak. This paper was presented at The Society for Surgery of the Alimentary Tract, 47th Annual Meeting at Digestive Disease Week 2006, May 20–24, 2006, Los Angeles, California.     

Methodologies,Devices, and New Surgical Concepts: Novel System for Percutaneous Cardiopulmonary Bypass

Percutaneous cardiopulmonary bypass (PCPB) has recently come to the forefront of medicine as a technique for resuscitating and supporting patients in various clinical situations. Current systems utilize small-diameter cannulas to aspirate blood under high suction into the cardiopulmonary bypass circuit. Aspiration-based systems have several disadvantages including risk of air embolism, blood hemolysis, and cavitation. Additionally, they are suboptimal for use during open-heart surgical procedures. A system with a venous cannula that employs gravity drainage has been evaluated. Once advanced into position over a guide- wire, the stylet is removed, causing the basket near the end of the cannula to expand. Blood flows into the cannula from side holes and the basket region, which prevents the vessel wall or atrium from collapsing around the catheter and impeding venous drainage. Hemodynamic, hematologic, and histologic examinations were performed on eight anesthetized mongrel dogs during 2 h of PCPB. All animals exhibited adequate tissue perfusion and right and left heart decompression. All animals were successfully weaned from PCPB and after 30 min exhibited normal myocardial function. No ischemic changes were observed in the heart, lung, kidney, or liver by light and electron microscopy. We conclude that full PCPB can be satisfactorily achieved by using a novel percutaneous venous cannula and gravity drainage     

Paracorporeal Artificial Heart in Postoperative Heart Failure

A pneumatically driven artificial heart with a tubular silicone rubber membrane and disc valves was used for functional heart replacement in the paracorporeal mode. A fluidic drive system allows adjustment of the heart rate, positive and negative pressures and systole/diastole ratio.
Since August, 1977, the artificial heart has been used in four patients with refractory postoperative heart failure not responding to volume loading, pH and electrolyte correction, catecholamines and intraaortic balloon pumping. Large cannulae were placed in the atria and great vessels. The ventricles were fixed on the chest paracorporeally. The assist system was used as a left heart bypass in one patient and as a biventricular bypass in three other patients. After 48–72 hours, the ventricular function recovered in three patients, permitting removal of the artificial heart. One patient died of cerebral complications six weeks later; the other two recovered completely and were released in good condition.
Profound postoperative heart failure can be completely reversed by the use of the paracorporeal artificial heart; the advantage of the system lies in the simplicity of its implantation and removal.