The Annals of thoracic surgery
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Case Reports
Weaning from venovenous extracorporeal membrane oxygenation without anticoagulation: is it possible?
A 19-year-old man affected with severe acute respiratory distress syndrome that was unresponsive to medical treatment was successfully weaned without anticoagulation therapy from venovenous extracorporeal membrane oxygenation (ECMO) because of life-threatening bleeding. The patient received venovenous ECMO with double peripheral cannulation. ⋯ The patient was discontinued from ECMO and extubated after pulmonary function improved. Based on this single experience, management and weaning without any anticoagulant agent might be possible.
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The aim of this study was to examine the impact of prolonged intensive care unit (ICU) stay on in-hospital mortality and long-term survival. ⋯ Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations.
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Comparative Study
Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.
Numerous studies have supported the effectiveness of recombinant activated factor VII (rFVIIa) for the control of bleeding after cardiac procedures; however safety concerns persist. Here we report the novel use of intraoperative low-dose rFVIIa in thoracic aortic operations, a strategy intended to improve safety by minimizing rFVIIa exposure. ⋯ Intraoperative low-dose rFVIIa led to improved postoperative hemostasis with no apparent increase in adverse events. Intraoperative rFVIIa administration in appropriately selected patients may correct coagulopathy early in the course of refractory blood loss and lead to improved safety through the use of smaller rFVIIa doses. Appropriately powered randomized studies are necessary to confirm the safety and efficacy of this approach.
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Comparative Study
Preoperative recipient cytokine levels are associated with early lung allograft dysfunction.
Primary graft dysfunction (PGD) is a morbid complication after lung transplant (LTx). Recipient before and after cytokine and chemokine profiles may be associated with a recipient's propensity to have PGD. ⋯ Higher before and after transplant cytokine/chemokine levels were found in LTx recipients who subsequently had PGD grade 2 or more. Our study demonstrates that the recipient's inflammatory state at the time of LTx may impact early allograft function. That could represent a potential target for pretransplant pharmacologic intervention.
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Case Reports
Temporary fenestration using venoatrial extracorporeal membrane oxygenation after the Fontan operation.
A 28.7-month-old male child who had undergone a Norwood operation and bidirectional cavopulmonary shunt at the age of 5 days and 6.6 months, respectively, underwent the extracardiac conduit Fontan operation. After the operation, high-volume resuscitation was needed, which led to high central venous pressure (CVP) and low arterial oxygen saturation. ⋯ This low-flow venoatrial ECMO immediately terminated the vicious cycle caused by high venous pressure in the Fontan circulation. He was weaned from ECMO and discharged home.