ABSTRACT
BACKGROUND: Tumor necrosis factor-alpha has been implicated in complications seen after cardiac operations with cardiopulmonary bypass. The release of tumor necrosis factor-alpha and its possible effects were studied in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass. METHODS: Twenty patients were studied, 10 with (group 1) and 10 without cardiopulmonary bypass (group 2). Serial blood samples were obtained before, during, and up to 48 hours after operation. Circulating tumor necrosis factor-alpha levels, leukocyte counts, and erythrocyte sedimentation rates were measured. Hemodynamic variables (blood pressure and heart rate), temperature, orotracheal intubation time, postoperative bleeding, and inotropic drug requirements were compared. RESULTS: Serum levels of tumor necrosis factor-alpha were detected in 6 patients (60%) in group 1 and none in group 2. The patients in group 1 had more hypotension than those in group 2 (7.4 +/- 1.0 mm Hg versus 8.5 +/- 0.7 mm Hg), required more inotropic drugs (8 patients versus 1 patient), and had a higher heart rate (114 +/- 8 beats per minute versus 98 +/- 10 beats per minute), a higher temperature (37.1 degrees +/- 0.5 degrees C versus 36.6 degrees +/- 0.3 degrees C), increased postoperative bleeding (820 +/- 120 mL versus 360 +/- 84 mL), a longer orotracheal intubation time (13.6 +/- 2.2 hours versus 9.3 +/- 1.4 hours), and a more pronounced leukocytosis. CONCLUSIONS: Cardiopulmonary bypass induces the whole-body inflammatory response through the release of tumor necrosis factor alpha, resulting in adverse systemic effects.
Subject(s)
Cardiopulmonary Bypass/adverse effects , Coronary Artery Bypass/adverse effects , Systemic Inflammatory Response Syndrome/etiology , Tumor Necrosis Factor-alpha/physiology , Blood Pressure/physiology , Blood Sedimentation , Body Temperature/physiology , Female , Follow-Up Studies , Heart Rate/physiology , Humans , Hypotension/etiology , Intubation, Intratracheal , Leukocyte Count , Leukocytosis/etiology , Male , Middle Aged , Myocardial Contraction/drug effects , Postoperative Hemorrhage/etiology , Systemic Inflammatory Response Syndrome/blood , Time Factors , Tumor Necrosis Factor-alpha/analysis , Tumor Necrosis Factor-alpha/metabolismABSTRACT
This is a case of a patient with two saccular aneurysms in the descending aorta. Two self-expanding stents were inserted through an opening in the aortic arch, guided by the use of an Olympus endoscope, under profound hypothermia and total circulatory arrest. The bloodless field made possible the identification of the main thoracic branches, facilitating the positioning and deployment of both stents. Immediate postoperative recovery was excellent.
Subject(s)
Angioscopy , Aortic Aneurysm, Thoracic/therapy , Stents , Aged , Angioscopes , Aorta, Thoracic/pathology , Aortic Aneurysm, Thoracic/pathology , Equipment Design , Heart Arrest, Induced , Humans , Hypothermia, Induced , Male , Mesenteric Artery, Superior/pathology , Polyethylene Terephthalates , Renal Artery/pathology , Steel , Suture TechniquesABSTRACT
We describe a case of a patient who had a ruptured aorta repaired by femorofemoral bypass with an interposition graft and subsequently had a graft infection. The patient was taken to operation and the old graft was removed. It was replaced by a spiral great saphenous vein graft. The patient has been followed up for 36 months with computed tomographic scanning, which has shown that the vein graft has not dilated.
