Artificial organs
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Clinical Trial Controlled Clinical Trial
Biventricular bypass with oxygenation for postcardiotomy ventricular failure.
Between January 1984 and March 1995, biventricular bypass (BVB) with oxygenation was used in 17 patients for postcardiotomy ventricular failure at the Heart Institute of Japan, Tokyo Women's Medical College. Of the 17 patients, 12 (70.6%) were weaned from the circulatory support, and 8 (47.1%) were discharged from the hospital. ⋯ Causes of death were severe heart failure or ventricular arrhythmia in 6 patients and multiple organ failure in 3 patients. These results suggest that early application and timely weaning from biventricular bypass with oxygenation might be the effective circulatory support of choice for treatment of postcardiotomy ventricular failure.
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Clinical Trial
Extracorporeal membrane oxygenation as a bridge to cardiac transplantation in children.
The feasibility and efficacy of extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation was examined in 6 pediatric patients who suffered irreversible myocardial failure after undergoing surgery for congenital heart defects. The mean time of ECMO support was 260.5 h, range 101-402 h. Three patients underwent transplantation, 2 of whom are long-term survivors. ⋯ Infection did not occur in any of the 6 patients. Exchanging ECMO components was performed with no difficulties; these exchanges included a centrifugal pump once for 3 patients and a membrane oxygenator once for 2 patients. Our results indicate that ECMO can safely keep critically ill pediatric transplant candidates alive for more than 1 week with a low incidence of multiple organ failure.
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We reviewed the role of the BioMedicus pump in the reduction of neurologic complications following the repair of Type 1 and Type 2 thoracoabdominal aortic aneurysms. Since 1991, we have used several different methods for the repair of thoracoabdominal aortic aneurysms including simple cross-clamping, selective use of the BioMedicus pump, cardiopulmonary bypass with or without profound hypothermia, and most recently, distal aortic perfusion using the BioMedicus pump combined with cerebral spinal fluid drainage. ⋯ On our service, the ongoing study of the BioMedicus pump and distal aortic perfusion in conjunction with cerebral spinal fluid drainage has shown that these adjuncts can extend the tolerance of the spinal cord to ischemia and lower the overall rate of neurologic complications for Type 1 and Type 2 thoracoabdominal aortic aneurysm repairs to a rate of 5% (early results) and 3% (late results). We highly recommend distal aortic perfusion using the BioMedicus pump combined with cerebral spinal fluid drainage for thoracoabdominal aortic aneurysm repair.
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Between January 1984 and March 1995, biventricular bypass (BVB) with oxygenation was used in 17 patients for postcardiotomy ventricular failure at the Heart Institute of Japan, Tokyo Women's Medical College. Of the 17 patients, 12 (70.6%) were weaned from the circulatory support, and 8 (47.1%) were discharged from the hospital. ⋯ Causes of death were severe heart failure or ventricular arrhythmia in 6 patients and multiple organ failure in 3 patients. These results suggest that early application and timely weaning from biventricular bypass with oxygenation might be the effective circulatory support of choice for treatment of postcardiotomy ventricular failure.
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A review and analysis of 5,001 neonatal venoarterial (VA) extracorporeal membrane oxygenation (ECMO) cases showed that bacterial and fungal infection occurred in 147 (2.9%) and 26 (0.6%) patients, respectively, with an overall incidence of 3.5%. Bivariate analysis was used to compare infected infants with controls, bacterial versus fungal groups, and bacterial subgroups with respect to patient demographics, primary diagnosis, mechanical complications, patient complications, duration of the ECMO course, and hospital mortality. Logistic regression models were constructed using variables that were statistically significant from the bivariate comparisons. ⋯ The infection group had significantly longer mean total hours on bypass and higher hospital mortality. Infants with fungal infection had a significantly higher hospital mortality rate compared with those with bacterial infection. We conclude that infection during ECMO, especially fungal infection, carries an increased risk of hospital mortality and that mechanical complications are associated with an increased risk of infection, Key Words: Extracorporeal membrane oxygenation-Nosocomial-Bacterial infection-Fungal infection-Extracorporeal membrane oxygenation outcome.