Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2009
Case ReportsIntra aortic balloon pump insertion through left axillary artery in patients with severe peripheral arterial disease.
Intra aortic balloon pump (IABP) is the mechanical assist device most frequently used in cardiac surgery. Recent demonstration of better outcome following preoperative IABP insertion in high-risk patients has further extended its indication. However, due to an increasing complexity of patients currently referred for cardiac surgery, several patients with potential indication for preoperative and/or postoperative IABP present severe peripheral vascular disease which usually contraindicates IABP insertion. Here we present an alternative technique for IABP insertion in patients with severe peripheral vessel disease.
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Interact Cardiovasc Thorac Surg · Aug 2009
Left ventricular performance in aortic valve replacement.
We analyzed the mid-term left ventricular (LV) performance after aortic valve replacement (AVR). We measured LV contractility (end-systolic elastance: Ees), afterload (effective arterial elastance: Ea) and efficiency (ventriculoarterial coupling: Ea/Ees; ratio of stroke work and pressure-volume area: SW/PVA) based on transthoracic echocardiography data obtained before, after and approximately 1 year after isolated AVR in 263 patients with aortic stenosis (AS group; n=116), aortic regurgitation (AR group; n=93) or aortic stenosis and regurgitation (ASR group; n=54). The LV volume was calculated by the Teichholz M-mode method. ⋯ Contrasting effects of AVR on LV contractility and afterload between AS and AR were clearly demonstrated. The mid-term LV contractility and efficiency after AVR were excellent and satisfactory. However, LV efficiency worsened early after AVR in AR patients.
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Interact Cardiovasc Thorac Surg · Aug 2009
How to replace an extracorporeal life support without interruption of the cardiopulmonary assistance.
The extracorporeal life support (ECLS) allows a maximum of a few weeks of cardio-respiratory assistance. Using standard ECLS, the circuit must be replaced after a few days or sometimes more frequently, in case of dysfunction. Classically, the replacement needs the interruption of the support inducing a temporarily hemodynamic instability. ⋯ We describe the original modification, the complete procedure and our results. This method has been used in 34 ECLS replacements in 14 patients without any incident or thrombo-embolic events. This simple technique is safe, reliable, and avoids the hemodynamic instability induced by classical replacements.
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Interact Cardiovasc Thorac Surg · Aug 2009
Prophylactic intra-aortic balloon pump in high-risk patients undergoing coronary artery bypass grafting: a propensity score analysis.
The optimal use of prophylactic intra-aortic balloon pump (IABP) to prevent postcardiotomy low cardiac output syndrome (LCOS) is still debated and poorly defined. The aim of this study was to evaluate whether prophylactic IABP reduces the rate of postcardiotomy LCOS and improves the early outcome in hemodynamically stable, high-risk patients undergoing coronary artery bypass grafting (CABG). From May 2004 to August 2007, 141 consecutive risk patients underwent CABG. ⋯ Prophylactic IABP patients were more likely to be younger (P<0.0001), had a recent myocardial infarction (P<0.0001), lower ejection fraction (P=0.006), and higher New York Heart Association (NYHA) functional class (P=0.05). After risk-adjusting for propensity score, prophylactic IABP patients had a lower incidence of postcardiotomy LCOS (adjusted OR 0.07, P=0.006), postoperative myocardial infarction (adjusted OR 0.04, P=0.04), a shorter length of hospital stay (10.4+/-0.8 vs. 12.2+/-0.6 days, P<0.0001) than those who did not receive IABP. This study shows that prophylactic IABP treatment for hemodynamically stable high-risk patients undergoing CABG may improve postoperative course reducing postcardiotomy LCOS, postoperative myocardial infarction and length of hospital stay.