Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2014
Case ReportsDouble lung procurement from a donor supported by a left ventricular assist device.
Over the past several years, the selection criteria for marginal donor lungs have been extended. However, brain-dead patients with implanted mechanical circulatory support systems have not yet been considered as potential organ donors for lung transplantation. Our report presents the first successful procurement and transplantation of donor lungs from a patient supported by a left ventricular assist device. ⋯ The subsequent sequential bilateral lung transplantation was performed without complications. Postoperative course and follow-up were uneventful. This case demonstrates the feasibility of lung transplantations from organ donors supported by a mechanical circulatory support system.
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Interact Cardiovasc Thorac Surg · Jul 2014
Selective reduction of afterload in right heart assist therapy: a mock loop study†.
The treatment of right ventricular failure is closely linked to effects on pulmonary vascular resistance and thus the right ventricular (RV) afterload. Medical therapy includes afterload-decreasing drugs such as nitric oxide and prostacycline. However, current devices for mechanical unloading of the right ventricle aim at a decrease in preload increasing the pulmonary volume loading. In our concept study, we tested a minimally invasive right ventricular assist device (MIRVAD) that specifically reduces the afterload. ⋯ The feasibility of RV unloading by a selective decrease in RV afterload was proved in principle. By alternation of the pump speed, gradual reloading in sense of a myocardial training may be achieved. The results will be validated by future animal trials where the relationship between the level of support and pulmonary vascular pressure can be investigated in vivo. Further device design concerning foldable impeller leaflets will be carried out. At a final stage, the crimped version is supposed to reach a size below 1 cm to facilitate minimally invasive insertion.
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Interact Cardiovasc Thorac Surg · Jul 2014
A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery.
To determine in the modern era if cardiopulmonary bypass (CPB) time has a significant effect on postoperative morbidity, mortality and long-term survival in patients undergoing isolated aortic valve replacement (AVR) surgery. ⋯ Despite improvements over time with regard to morbidity, mortality and long-term survival, CPB time remains a significant factor determining mediastinal blood loss, ICU and hospital length of stay, and in-hospital mortality.
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Interact Cardiovasc Thorac Surg · Jul 2014
Case ReportsSimultaneous cusp-sparing aortic root replacement and coarctectomy with total arch replacement from the midline incision.
Four cases of simultaneous surgery for aortic root aneurysm with aortic regurgitation and coarctation of the aorta were presented. Age at surgery ranged from 18 to 37 years and all were male. All had annuloaortic ectasia and dilatation of the ascending aorta, 3 had bicuspid aortic valve and 1 had acute localized aortic dissection. ⋯ Antegrade cerebral perfusion was used for brain protection. All patients survived and postoperative pressure difference between the upper and lower extremities disappeared. Postoperative aortogram was satisfactory.
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Interact Cardiovasc Thorac Surg · Jul 2014
Impact of vacuum-assisted closure therapy on outcomes of sternal wound dehiscence†.
Sternal wound dehiscence (SWD) after cardiac surgery is a rare but serious condition associated with considerable costs and morbidity. We sought to evaluate the results of the introduction of vacuum-assisted closure (VAC) therapy in the management of sternal wound dehiscence, compared with those of previous conventional treatments. ⋯ In our experience, the use of VAC therapy for the management of SWD was considerably effective in decreasing mortality (SWD related), incidence of complications and need for surgical procedures; thus, leading to a significant reduction of costs.