The Annals of thoracic surgery
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Extracorporeal life support (ECLS) is an effective technique for providing emergent circulatory assistance. However, its use in adult patients is associated with poor survival when myocardial function fails to recover. Due to the prolonged waiting times for heart transplantation, ECLS as a bridge to transplant is associated with poor survival. In addition, ECLS has been reported to be a significant risk factor for death after bridging to an implantable left ventricular assist device (LVAD). After acquisition of the HeartMate LVAD (Thermo Cardiosystems, Inc) in October 1996, we began using ECLS as a bridge to an implantable LVAD and subsequently transplantation in selected high-risk patients. ⋯ In selected high-risk patients, LVAD survival after initial ECLS was not different from survival after LVAD support alone. An initial period of resuscitation with ECLS is an effective strategy to salvage patients with cardiac arrest or extreme hemodynamic instability and multiorgan injury.
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Recent reports claim that cardiomyoplasty (CMP) has a girdling effect on the left ventricle, to prevent dilatation and functional deterioration, but the mechanism of its long-term effects on the native heart is not known. We compared the relative role of CMP's active squeezing and passive girdling in chronically failing hearts. ⋯ Dynamic CMP improved native heart's contractility and external work efficiency. In addition, whereas passive CMP has simply a girdling effect, dynamic CMP also induces reverse left ventricular chamber remodeling.
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Comment Letter Case Reports
Myocardial infarction after partial left ventriculectomy.
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Clinical Trial
Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation.
Right ventricular failure from elevated pulmonary vascular resistance in the recipient is a main cause of early mortality after heart transplantation. When pharmacologic treatment is insufficient, mechanical circulatory assistance has been used to support the failing right ventricle. Considering right and left ventricular interdependence, we investigated whether intraaortic balloon counterpulsation (IABP) might also alleviate predominantly right ventricular dysfunction after heart transplantation. ⋯ Intraaortic balloon pumping is a minimally invasive circulatory assist device with proved efficiency in low cardiac output syndromes. This report shows that low output syndrome caused by predominantly right ventricular allograft failure may be an additional indication for IABP.
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Biography Historical Article
Norman Bethune and Edward Archibald: sung and unsung heroes.
Edward Archibald was a pioneer, master thoracic surgeon. He laid the foundation for surgical research in Canada and made fundamental contributions to the training and certification of surgeons. ⋯ Norman Bethune, with a flair for publicity, used extraordinary measures and delivered them heroically with talent and total dedication, ignoring conventional approaches. He became a truly sung hero.