The Thoracic and cardiovascular surgeon
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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).
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Thorac Cardiovasc Surg · Apr 2012
Multicenter StudyRisk factors for distal Contegra stenosis: results of a prospective European multicentre study.
Objectives The EUCon study was designed to identify risk factors for distal anastomotic stenosis after bovine jugular vein (Contegra) implantation in children. Methods Between March 2006 and August 2008, 104 devices were implanted in nine European centers. Preoperative, intraoperative, and follow-up data (at discharge, 6, 12, 24 months) including standardized echocardiography were prospectively registered, source data verified and collected in a central database. ⋯ Age <2 years was the only invariably significant risk factor (p = 0.044); "Clustering By Response" found young anticoagulated patients with oversized conduits to be at a higher risk than the others (p = 0.018, OR = 3.2). Conclusion Patient age is the main risk factor for development of distal anastomosis stenosis after Contegra implantation. The influence of the other investigated factors is too small to be proven in 104 patients after 2 years, or other risk factors must be taken into consideration to explain outcome differences among recipients under 2 years.
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Thorac Cardiovasc Surg · Apr 2012
ReviewDoes bilateral pulmonary banding in comparison to Norwood procedure improve outcome in neonates with hypoplastic left heart syndrome beyond second-stage palliation? A review of the current literature.
Best evidence protocol was applied and the question addressed, whether there is an outcome advantage of a hybrid approach including bilateral pulmonary banding (BPB) and ductal stenting over Norwood procedure (NP) to maintain systemic circulation and to restrict pulmonary blood flow in neonates with hypoplastic left heart syndrome (HLHS). Out of 80 articles published since the original description of BPB in 2002, eight were selected to answer the clinical question. All studies were retrospective case-series after BLB, only three compared results with NP controls, but not in a randomized fashion. ⋯ Estimated transplant-free survival beyond stage 2 palliation ranged from 7 to 80%, with no significant differences to NP controls in three studies. Reintervention rate was high, ranging from 20 to 42% at different sites. Due to study design or inhomogeneity of patient groups, current literature does not show evidence that bilateral pulmonary banding improves outcome with respect to survival beyond second-stage HLHS palliation.
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Thorac Cardiovasc Surg · Mar 2012
Case ReportsLobar torsion after video-assisted thoracoscopic lobectomy: 2 case reports.
Lung torsion is a rare but potentially lethal complication after pulmonary resection. We report two cases of right middle lobar torsion after video-assisted thoracoscopic (VATS) right upper lobectomy in our unit. ⋯ VATS lobectomy contributes to the development of lobar torsion so this complication should be considered. Carefully checking anatomical structures before thoracotomic closure and correctly suturing the middle lobe to the consecutive lobe are effective ways to prevent this complication.