Risk factors for stroke after coronary artery bypass grafting (CABG) were assessed. We retrospectively investigated 681 consecutive patients who underwent isolated, first-time CABG at our institute between 1987 and 1998. Ninety-eight patients (14%) had a history of preoperative stroke. They tended to be older and with a higher incidence of peripheral vascular disease (PVD) than those without preoperative stroke. In spite of several techniques for prevention of postoperative stroke, such as the aortic non-touch technique, 14 patients (2.0%) suffered postoperative stroke. Postoperative stroke was diagnosed soon after surgery in 7 patients (50%), and the causes of stroke in these patients seemed to be intraoperative manipulation of the ascending aorta in 5, and hypoperfusion during cardiopulmonary bypass in two. Stroke in the remaining 7 patients occurred after normal awakening from anesthesia, and the cause was unknown. We then compared the patients with postoperative stroke (n=14) to those without postoperative stroke (n=667). Statistical analysis demonstrated no significant difference between the two groups in variables such as history of preoperative stroke, duration of cardiopulmonary bypass, and prevalence of PVD. Four (29%) of the patients with postoperative stroke died, due mainly to aspiration pneumonia. The morbidity and mortality of the patients who suffered postoperative stroke were very high.

The effectiveness of recombinant human erythropoietin (rHuEPO) was evaluated in elderly patients who underwent coronary artery bypass grafting. A total of 133 patients were divided into three groups: those who were 70 years of age or older and received rHuEPO (group I; n=32), those who were also 70 years of age or older but did not receive rHuEPO (group II; n=35), and those who were 60 years or younger and received rHuEPO (group III; n=66). In 87.5% of group I, 42.9% of group II, and 98.5% of group III, homologous blood transfusion could be avoided. The percentage of patients without homologous blood transfusion was significantly higher in group I than in group II (p<0.001). The rate of homologous blood transfusion was significantly higher in group I than in group III (p<0.05), but rHuEPO had equal effects in terms of increase in hemoglobin level in the two groups. Furthermore, in patients without anemia, the rate of homologous blood transfusion was almost the same in the two groups. In conclusion, the administration of rHuEPO enables even elderly patients to undergo coronary artery bypass grafting without homologous blood transfusion.

From January 1987 to October 1992, 60 consecutive patients operated on for infrarenal abdominal aortic aneurysm (AAA) were reviewed to evaluate the effect of previous laparotomies giving on the results of aneurysmal surgery. Eleven of 60 patients had previous laparotomies. Two of them required emergency operation for ruptured aneurysms. One of them died during surgery as a result of excessive hemorrhage prior to cross-clamping the aorta. Severe peritoneal adhesion had made if difficult to properly expose the aorta for cross-clamping to control hemorrhage. There were no statistical significance in mortality between the previous laparotomy and non-laparotomy groups. Excluding ruptured cases, we compared the previous laparotomy group (9 patients) and non-laparotomy group (37 patients) with reference to perioperative factors, including operation time, blood loss, non-oral feeding days, bed-ridden days, and hospital stay but there were no statistically significant differences. These results suggested that previous laparotomy is not a serious risk factor in operations for AAA.

Fifteen consecutive patients with true or dissecting aneurysms of the thoracic descending aorta, and thoraco-abdominal aorta were operated upon under left thoracotomy with the support of partial cardiopulmonary bypass, equipment composed of a membrane oxygenator, centrifugal pump, and percutaneous thin wall cannulae which were all coated with covalently bonded heparin. The polyvinyl tube was coated with Biomate. The administration of systemic heparin was determined by an ACT of around 200 seconds. One perioperative death in a case treated by emergency operation for a ruptured descending aortic aneurysm occurred due to acute myocardial infarction. Other patients tolerated their operation well and are alive. No thromboembolic accident, bleeding tendency, nor organ failure were observed postoperatively in any other patients. In conclusion, the cardiopulmonary bypass using an antithrombotic circuit is safe and recommendable for thoracic descending or thoraco-abdominal aneurysm operations.