Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2009
Comparative StudyCardiac output by arterial pulse contour: reliability under hemodynamic derangements.
Pulse contour methods (PCM) for the measurements of cardiac output (CO) are gaining popularity in intensive care settings but their reliability during hemodynamic instability has been questioned. Pressure-recording-analytical-method (PRAM) is a newly developed uncalibrated hemodynamic monitor and its capability in measuring CO during hemodynamic instability is still under investigation. Dobutamine (2.5 and 5 microg/kg/min), vasoconstriction (arginine-vasopressin 4, 8 and 16 IU/h), hemorrhage (-10%, -20%, -35%, and -50% of the theoretical volemia), and volume resuscitation were induced in eight swine. ⋯ CO(TEE): r(2)=0.38, bias=0.4 l/min, precision=+/-1.42 l/min, limits of agreement=-0.99+1.79 l/min, and percentage error=62%. PRAM resulted to be accurate in measuring CO during hemodynamic stability, tachycardia, and vasoconstriction. When volemia was reduced by >35%, disagreement between methods was observed.
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Interact Cardiovasc Thorac Surg · Jun 2009
Case ReportsThe Impella LP 5.0 as a bridge to long-term circulatory support.
Multi-organ failure (MOF) secondary to bi-ventricular cardiac dysfunction is a major therapeutic challenge. In addition to aggressive medical therapy, it frequently requires circulatory support with uni- or bi-ventricular assist devices. ⋯ We present a case of a patient in bi-ventricular failure successfully bridged to permanent circulatory support. Relative merits of this therapeutic approach are outlined and discussed.
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Interact Cardiovasc Thorac Surg · Jun 2009
Case ReportsAortic valve thrombosis after implantation of temporary left ventricular assist device.
The use of assist devices for ventricular support after myocardial infarction with cardiogenic shock has become common practice. Thrombosis, bleeding, and infection are common complications. However, native valve thrombosis is a rare complication. We present a case of aortic valve thrombosis after implantation of a left ventricular assist device (LVAD) treated with thrombus removal at time of device exchange.
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Interact Cardiovasc Thorac Surg · Jun 2009
Comparative StudySelective antegrade cerebral perfusion at two different temperatures compared to hypothermic circulatory arrest--an experimental study in the pig with microdialysis.
Hypothermic arrest and selective antegrade cerebral perfusion (SACP) is widely used during aortic arch surgery. The microdialysis technique monitors biomarkers of cellular metabolism and cellular integrity over time. In this study, the cerebral changes during hypothermic circulatory arrest (HCA) at 20 degrees C and HCA with SACP at two different temperatures, 20 and 28 degrees C, were monitored. ⋯ The largest increase of glycerol was found in the group with tepid cerebral perfusion (28 degrees C) and the HCA group (P<0.05). This study supports the use of SACP over arrest. It also suggests that cerebral metabolism and cellular membrane integrity may be better preserved with SACP at 20 degrees C compared to 28 degrees C.
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Interact Cardiovasc Thorac Surg · Jun 2009
Clinical application of an ultrasonic scalpel to divide pulmonary vessels based on laboratory evidence.
The Harmonic Ace ultrasonic scalpel (Ethicon Endo-Surgery, Inc, Cincinnati, Ohio), has been widely used in endoscopic surgery to divide systemic vessels, but not pulmonary vessels. We describe our initial clinical experience of using it for pulmonary vessel division. The Harmonic Ace was used to divide pulmonary vessels 5 mm or less in diameter, secured with a proximal single ligation, in 20 patients who underwent video-assisted major lung resection between September 2007 and April 2008. ⋯ There was no postoperative bleeding. In the pig model, the bursting pressure of sealed pulmonary arteries (PA) was >75 mmHg. Pulmonary vessels can be safely divided using the Harmonic Ace with proximal single ligation unless multiple or large pulmonary vessels are held within the blade jaw.