Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2013
Comparative StudyHaemodynamic comparison of a novel flow-divider Optiflo geometry and a traditional total cavopulmonary connection.
The total cavopulmonary connection (TCPC), the current palliation of choice for single-ventricle heart defects, is typically created with a single cylindrical tunnel or conduit routing inferior vena caval (IVC) flow to the pulmonary arteries. Previous studies have shown the haemodynamic efficiency of the TCPC to be sub-optimal due to the collision of vena caval flow, thus placing an extra energy burden on the single ventricle. The use of a bifurcated graft as the Fontan baffle (i.e. the 'Optiflo') has previously been proposed on the basis of theoretically improved flow efficiency; however, anatomical constraints may limit its effectiveness in some patients. ⋯ This study demonstrated proof of concept that the flow-divider has the potential to reduce power loss and streamline IVC flow through the TCPC. An appropriate size for the insert in proportion to the Fontan baffle size was identified that reduced losses compared with a TCPC control under both resting and simulated exercise flow conditions.
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Interact Cardiovasc Thorac Surg · Jul 2013
ReviewShould we perform bilateral-lung or heart–lung transplantation for patients with pulmonary hypertension?
A best evidence topic was constructed according to a structured protocol. The following question was addressed: of the following two procedures, heart–lung transplantation or bilateral-lung transplantation (BLTx), which offers the best outcome for patients with pulmonary hypertension (PH) listed for thoracic transplantation? Of the 77 papers found using a report search for PH and thoracic transplantation, 9 represented the best evidence to answer this clinical question. Overall, 1189 (67%) lung transplantations and 578 (33%) heart–lung transplantations have been reported worldwide for idiopathic PH. ⋯ In the case of lower values for RVEF and LVEF, HLTx should be performed. In all other patients with PH, the evidence demonstrated that BLTx offers a comparable outcome with the advantage of better organ sharing for other recipients. In order to reduce the waiting time on transplantation lists, cardiac repair and BLTx can be offered in experienced centres to patients with simple cardiac anomalies such as atrial septal defect, patent ductus arteriosus or perimembranous ventricular septal defect.
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Interact Cardiovasc Thorac Surg · Jul 2013
Impact of mitral annular calcification on early and late outcomes following mitral valve repair of myxomatous degeneration.
Mitral annular calcification is associated with significant morbidity and mortality at the time of mitral valve surgery. However, few data are available describing the impact of mitral annular calcification on early and late outcomes following mitral valve repair in the current era. ⋯ Risk factors for mitral annular calcification in patients with myxomatous degeneration and severe mitral regurgitation include older age, female gender, severe renal dysfunction and larger preoperative left atrial size. Nevertheless, favourable early and late results can be achieved with mitral valve repair in this population.
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Interact Cardiovasc Thorac Surg · Jul 2013
Outcomes in the current surgical era following operative repair of acute Type A aortic dissection in the elderly: a single-institutional experience.
We reviewed our single-centre experience with emergent operative repair of Stanford Type A aortic dissections, with particular attention to outcomes in the elderly. ⋯ Excellent operative outcomes can be achieved in elderly patients undergoing emergent repair of Type A aortic dissections. Advanced patient age should therefore not serve as an absolute contraindication to operative repair in this high-risk cohort.
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Interact Cardiovasc Thorac Surg · Jul 2013
Case ReportsLong-term membrane oxygenator use to support an infant with acute respiratory distress syndrome on biventricular assist device.
Ventricular assist devices (VADs) are used in children with severe heart failure as a bridge to heart transplantation or recovery. Severe pulmonary dysfunction may preclude their use, leaving extracorporeal membrane oxygenation (ECMO) as the most frequently used option for combined cardiac and respiratory failure. There are few case reports describing the use of an oxygenator in combination with VAD support, but none that describes long-term utilization. ⋯ An oxygenator used in conjunction with a VAD may be a life-saving therapy, allowing adequate oxygenation and ventilation in severe respiratory and cardiac failure. Extended use may facilitate the prevention of ventilator-associated lung injury and organ dysfunction. This therapy may be an attractive intermediate step in the transition from, or alternative to ECMO, in patients requiring VAD placement with associated acute lung injury.