Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2007
Intra-aortic balloon counterpulsation in decompensated cardiomyopathy patients: bridge to transplantation or assist device.
The crucial decision to progress from pharmacological treatment of acute decompensated heart failure to institution of assist device or transplantation begins with evaluation of the chances for a successful recovery. We tested whether the intra-aortic balloon counterpulsation (IABP) could give us the necessary time for clinical decision-making and preserve adequate circulation until it is made. ⋯ Our data showed that intra-aortic balloon pump support may be successfully and safely used in the acute decompensated dilated cardiomyopathy patients, as an urgent measure of cardiac support, to stabilize the patient and maintain organ perfusion until transplant is available, VAD is placed or patient is weaned from IABP.
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Interact Cardiovasc Thorac Surg · Feb 2007
Fast-track approach in abdominal aortic surgery: left subcostal incision with blended anesthesia.
The introduction of fast-tracking multidisciplinary programs allows good results in postoperative outcome in many surgical specialties. We evaluated a multimodal clinical program (based on mininvasive surgery, epidural anesthesia and early mobilization and feeding) in abdominal aortic surgery. ⋯ Our experience suggested that hospital stay and morbidity after abdominal aortic surgery can be decreased by performing a mininvasive surgical approach, thoracic epidural anesthesia-analgesia and an aggressive postoperative nursing on the ward. Therefore, this multidisciplinary program can be proposed to all patients undergoing aortic surgery without prior selection, major technological investments and long-term surveillance.
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Interact Cardiovasc Thorac Surg · Feb 2007
Case ReportsValve-sparing aortic root replacement with repair of leaflet prolapse after Ross operation.
The need for reoperation remains a principal limitation of the Ross procedure and most commonly includes replacement of the neo-aortic valve. Valve-preserving aortic root replacement has recently evolved into an increasingly accepted treatment modality for patients with neo-aortic valve regurgitation. ⋯ Alternatively, valve preservation may be combined with correction of leaflet prolapse. We describe the use of a valve-sparing procedure with correction of leaflet prolapse in a patient with progressive dilatation of the pulmonary autograft and severe regurgitation of the neo-aortic valve.
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Acute massive pulmonary embolism has a high mortality rate despite advances in diagnosis and therapy. Thrombolysis and catheter embolectomy have recently shown various degrees of failure and adverse effect. Surgical embolectomy has now been liberalised for haemodynamic stable patients with right ventricular dysfunction. ⋯ Rescue embolectomy for very compromised patients remains a current treatment for massive PE. Furthermore, surgical embolectomy in haemodynamically stable patients is an immediate and definitive treatment for PE, with excellent long-term results. Keeping in mind that thrombolysis and catheter embolectomy have varying degrees of failure and risk, we propose surgical embolectomy in (sub)massive pulmonary embolism as an alternative procedure, or even as a primary treatment.
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Interact Cardiovasc Thorac Surg · Feb 2007
The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option?
The bidirectional cavopulmonary (Glenn) shunt is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair. It is usually performed under cardiopulmonary bypass with its associated adverse effects and costs. We report our results of bidirectional Glenn operation done without cardiopulmonary bypass. ⋯ Our results show that in selected patients, bidirectional Glenn operation without cardiopulmonary bypass is a safe procedure. It avoids cardiopulmonary bypass related problems and is economical, with excellent results.