The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2009
Case ReportsSwitch from assist device to total artificial heart to improve cardiac output.
Left ventricular assist devices (LVADs) offer the opportunity to substantially improve the clinical condition and to interrupt the hospitalization of patients suffering from end-stage heart failure awaiting heart transplantation. We report a case of a 30-year-old patient (body surface area 2.49 m2) suffering from idiopathic dilative cardiomyopathy who was primarily given an LVAD with a free floating impeller pump and was finally switched to a total artificial heart due to the demand for a higher cardiac output.
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Thorac Cardiovasc Surg · Feb 2009
Preoperative platelet inhibition with ASA does not influence postoperative blood loss following coronary artery bypass grafting.
Platelet inhibition is thought to increase perioperative blood loss in patients with planned coronary artery bypass grafting (CABG). This retrospective study reviews the results of over 10 000 patients with CABG, comparing continued platelet inhibition with preoperative disruption of this therapy. ⋯ Preoperative aspirin therapy does not seem to influence the operative outcome of isolated CABG. Therefore, the often given recommendation to stop this therapy prior to elective CABG procedures should be abandoned.
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Thorac Cardiovasc Surg · Feb 2009
Recurrent pleural effusion: who benefits from a tunneled pleural catheter?
Recurrent malignant pleural effusion (MPE) is a common concomitant phenomenon of malignant disease, which can worsen the patient's quality of life and lead to significant morbidity. Tunneled indwelling pleural catheters (TIPC) offer new modalities in patients with recurrent MPE and impaired dilatability of the lung. We report on our experience with 100 consecutive patients suffering from recurrent benign (n = 12) and malignant pleural effusion (n = 88) who were treated with TIPC. ⋯ The median residence time of the TIPC was 70 days; spontaneous pleurodesis was achieved in 29 patients. The rate of complications was low: pleura empyema (n = 4), accidental dislodgement (n = 2), malfunction of the drainage (n = 3). In conclusion, TIPC is a useful method for the palliative treatment of patients with recurrent malignant or nonmalignant pleural effusions and 3 groups of patients seem to benefit most: a) patients with the intraoperative finding of a trapped lung in diagnostic VATS procedure; b) patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis; c) patients in a reduced condition with a limited lifespan due to underlying disease.