The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jun 2012
Case ReportsSuccessful weaning from extracorporal circulation using a pumpless extracorporal lung assist device in a patient with intraoperative hypercapnic lung failure during aortic valve replacement.
We present a case of a 59-year-old female suffering from massive pulmonary edema with consecutive hypercapnic lung failure immediately following elective aortic valve replacement. Due to severe restrictive ventilation disorder, mechanical ventilation was inadequate. ⋯ The further clinical course and follow-up at 3 months remained uneventful. This report describes the first intraoperative use of the PECLA device in a cardiac surgery patient to promote weaning from ECC.
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Thorac Cardiovasc Surg · Jun 2012
Pediatric donor lungs for adult transplant recipients: feasibility and outcomes.
There is a limited experience using pediatric organs for adult lung transplantation (LTx), with size matching the major concern. We reviewed our experience transplanting pediatric donor lungs into adult recipients with endpoints of post-LTx complications and overall patient survival. ⋯ Despite sizing concerns, transplantation of pediatric lungs into adult recipients is feasible. Size mismatch may predispose to higher rates of airway and pleural complications. Hospital course and overall survival appear comparable to adult-to-adult LTx, and concerns over size matching should not preclude pediatric organ use for adult candidates.
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Thorac Cardiovasc Surg · Jun 2012
Case ReportsUse of Impella 5L for acute allograft rejection postcardiac transplant.
The contribution of acute allograft rejection to posttransplant mortality has decreased over time primarily due to improvements in maintenance immunosuppression and in the diagnosis and treatment of rejection. Nevertheless, acute heart allograft rejection remains an important clinical problem.2 In the setting of an acute allograft rejection, mechanical circulatory support has been provided by a variety of devices, ranging from intra-aortic balloon pumps (IABP) to extracorporeal membrane oxygenators (ECMO), left ventricular assist devices (LVADs) and biventricular assist devices (BIVADs).2 We present a 45-year-old patient with cardiogenic shock secondary to acute allograft rejection after orthotopic heart transplantation. Patient continued to have poor hemodynamics and low cardiac output despite being on high doses of inotropes and an aggressive immunosuppression. Hence, a decision was made to support the hemodynamics with an Impella LP 5.0 (Abiomed Inc, Danvers, MA) left ventricular assist device (LVAD).