The Annals of thoracic surgery
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The combination of transposition of the great arteries and coarctation of the aorta (TGA/CoA) presents a surgical challenge. We have adopted a concurrent aortic arch repair and arterial switch operation with excellent results. These patients tend to have a small aortic (ie, neopulmonary) annulus. This study evaluates the significance of right-sided obstruction after single-stage repair of TGA/CoA. ⋯ Neonatal single-stage repair for TGA/CoA achieves excellent survival without transannular patch repair at the first operation. Although some of the patients have pressure gradient across the RVOT, these lesions were amenable to reintervention with minimal morbidity.
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Comparative Study
Late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction.
The ideal preservation strategy has yet to be established in lung transplantation. This clinical study compares primary graft dysfunction using antegrade and retrograde perfusion of donor lungs. ⋯ Our results suggest that late retrograde perfusion of donor lungs does not decrease the severity of primary graft dysfunction when compared with standard antegrade techniques.
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Case Reports
Prolonged extracorporeal membrane oxygenation and circulatory support as bridge to lung transplant.
A 38-year-old man with progressive alveolitis secondary to polymyositis was treated for 52 days with venovenous and venoarterial extracorporeal membrane oxygenation as a bridge to bilateral lung transplantation. The patient survived, despite multiple complications, and is now back home with good pulmonary function. ⋯ This case shows that long-term extracorporeal lung assist is a viable but demanding alternative for bridging patients to pulmonary transplantation. This case also shows that right ventricular failure necessating conversion to veno-arterial assist does not necessarily predict right ventricular failure post-transplant.
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Inflammatory myofibroblastic tumor arising in the anterior mediastinum is rare. A 58-year-old woman had an anterior mediastinal mass invading the sternum, pericardium, and pleura. It was completely resected and found to be an inflammatory myofibroblastic tumor. The patient was well and had no recurrence 6 months after surgery.
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Comparative Study
Improved survival and decreasing incidence of adverse events with the HeartMate II left ventricular assist device as bridge-to-transplant therapy.
Pulsatile left ventricular assist devices (LVADs) are effective as bridge-to-transplant therapy, but they are limited by their large size and lack of durability. Smaller, more durable, continuous flow devices such as the HeartMate II LVAD are increasingly being used. The aim of this study is to report our single-center experience with this device as bridge-to-transplant therapy. ⋯ Despite morbidity, use of the HeartMate II LVAD as bridge-to-transplant therapy is associated with excellent survival and low mortality rates. We found a marked decrease in morbidity related to right ventricular failure, to device-related infections, and to thromboembolic events. However, the requirements for anticoagulation therapy may be associated with increased mediastinal and gastrointestinal bleeding. Strategies to optimize anticoagulation therapy may further improve results for these critically ill patients.