Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jan 2009
Case ReportsPossibilities and limitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure.
In cardiac surgery extracorporeal life support systems (ECLS), also known as extracorporeal membrane oxygenation systems (ECMO), are often placed in case of postcardiotomy shock, until the patient's myocardial pump function recovers. Patients under ECLS are typically intubated and immobilized. We present a 57-year-old man suffering from severe ischemic cardiomyopathy in biventricular failure and intractable cardiogenic shock, who was supported with a miniaturized cardiopulmonary bypass system (MECC((R))) installed as venoarterial ECLS for 37 days. ⋯ He then required intubation for pneumonia, but later underwent successful transplantation. In conclusion, this case demonstrates that ECLS with miniaturized heart-lung machines offer the possibility of prolonged and safe support, ideal as a bridge to decision in patients with cardiogenic shock. On the other side, this report also indicates that ECLS is not recommended as a bridge to transplantation on a routine basis.
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Interact Cardiovasc Thorac Surg · Jan 2009
Case ReportsNon-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery.
We present the case histories of two children having respiratory failure due to bilateral diaphragm paralysis after cardiac surgery. In both children non-invasive positive pressure ventilation alleviated respiratory distress, improved gas exchange, and prevented the need for endotracheal intubation. Following unilateral recovery of diaphragmatic function both children were successfully weaned from non-invasive positive pressure ventilation.
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Interact Cardiovasc Thorac Surg · Jan 2009
Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin.
In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30+/-11.2 months, 390 patients were assessed with Wald test-corrected chi(2) analysis to identify preoperative factors which correlate with a higher incidence of post-MIDCABG MI, PCI, CABG and mortality from cardiac causes. We found an increased incidence of postoperative MI in patients with 2-vessel (8.7%) and 3-vessel (7.7%) vs. 1.3% 1-vessel coronary artery disease (CAD) (P=0.023), and in patients with preceding cardiac procedure (CABG and PCI: 8.4% vs. 2.0% without, P=0.023). ⋯ Preoperative low ejection fraction (EF) (multivariate, P<0.001), preoperative MI (P=0.007) and extent of CAD (P=0.001) were associated with a higher post-MIDCABG mortality. None of the parameters correlated with subsequent CABG MIDCABG. The extent and history of CAD, history of cardiac interventions and low EF seem to influence the outcome adversely and should be considered deciding pro or against the MIDCAB-option.
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Interact Cardiovasc Thorac Surg · Jan 2009
Comparative StudyDifferences in the recovery of platelet counts after biological aortic valve replacement.
Observations among Karlsburg patients in 2006 revealed that the majority of very low platelet levels inducing postoperative heparin-induced-thrombocytopenia (HIT)-diagnostics with at the end negative results appeared related to aortic valve replacement (AVR) with stentless bioprostheses. We compared the postoperative courses of platelet counts in patients having had AVR with stentless prostheses (Sorin Biomedica Freedom Solo [SOLO]) or stented prostheses (Carpentier Edwards Perimount [PM]). Between February 2005 and April 2007, 209 patients received AVR with SOLO, in 137 patients a PM-prosthesis was implanted. ⋯ Differences in platelet counts between SOLO- and PM-subgroups were measured for day 2 (P=0.03), day 3 (P=0.0004) day 4 (P=0.0007), day 5 (P=0.0002) and at discharge (P<0.0001). Following intervention with conventional biological AVR, differences in the postoperative recovery of platelet counts can be detected, depending on the prosthesis used. The causes for and the clinical implications of this phenomenon are not yet assessed.