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  • Title: Hemodynamic effects of chest closure in adult patients undergoing cardiac surgery.
    Author: Adsumelli RS, Shapiro JR, Shah PM, Martella AT, Afifi AY, Risher WB, Hicks GL.
    Journal: J Cardiothorac Vasc Anesth; 2001 Oct; 15(5):589-92. PubMed ID: 11688000.
    Abstract:
    OBJECTIVE: To evaluate hemodynamic effects of sternal retractor removal and sternal closure after cardiopulmonary bypass and to correlate these changes with preoperative and intraoperative variables. DESIGN: Prospective. SETTING: University hospital. PARTICIPANTS: Fifty adults undergoing cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Arterial, pulmonary artery, and transesophageal echocardiography measurements were obtained immediately before and 1 minute after removal of the sternal retractor and immediately before and 1 minute after sternal closure. Retractor removal caused a significant decrease in cardiac index by 5.6% (p < 0.01), stroke volume index by 4.0% (p < 0.05), and mean pulmonary artery pressure by 4.8% (p < 0.001). Sternal closure caused a significant decrease in cardiac index by 7.7%, stroke volume index by 10.2%, and left ventricular end-diastolic area by 9.2% (p < 0.001) There were significant increases in pulmonary capillary wedge pressure and systemic vascular resistance by 9.1% and 10.8% (p < 0.01). There was no significant change in the ejection fraction area. The magnitude of decrease in stroke volume index with sternal closure correlated positively with end-diastolic area immediately before the closure. CONCLUSION: Chest closure is associated with significant hemodynamic changes and a change in the ventricular transmural pressure-volume relationship. Patients with lower preload immediately before closure are more vulnerable to a decrease in cardiac index. Based on the results of this study, volume appears to be the appropriate preventive and treatment option to limit the impact of chest closure.
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