European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2011
Mechanical bridging to orthotopic heart transplantation in children weighing less than 10 kg: feasibility and limitations.
Infants and young children are considered the most difficult group to bridge to orthotopic heart transplantation (OHT) and data regarding outcomes are scarce. ⋯ Mechanical bridging to transplantation is clinically feasible in children ≤ 10 kg, achieving excellent outcomes. Judicious use of VADs in smaller children will optimise the use of donor organs; however, the effect on overall OHT waiting times, if mechanical bridging was extended to a large number of small children, is unknown.
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Eur J Cardiothorac Surg · Mar 2011
Comparative StudyMinimizing bleeding associated with mechanical circulatory support following pediatric heart surgery.
The use of extracorporeal membrane oxygenation (ECMO) to support patients with early postcardiotomy heart failure may be associated with catastrophic bleeding, making its use undesirable. However, postcardiotomy mechanical circulatory assistance is necessary in some patients to allow for myocardial recovery. We have assembled a centrifugal pump system (CPS) that does not require early systemic anticoagulation. This study compares postoperative bleeding in pediatric patients placed on standard ECMO versus CPS within 24h of cardiotomy. ⋯ Mechanical circulatory support can be provided without the complication of clinically significant bleeding if a specialized circuit is used. This has important implications for the decision to use mechanical support in the immediate postoperative period in the face of ventricular failure. In addition, early mechanical support can be used with a low incidence of circuit-related complications.
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Eur J Cardiothorac Surg · Mar 2011
Case ReportsCoronary stenting for iatrogenic stenosis of the left main coronary artery post-aortic valve replacement: an alternative treatment?
Iatrogenic coronary ostial stenosis after aortic valve replacement is a rare, life-threatening complication, which may follow implantation of either a mechanical or a biological prosthesis. Historically, this condition has been treated by urgent coronary bypass surgery but is associated with high morbidity and mortality, due to the hazards of early repeat sternotomy. We report a case of iatrogenic coronary ostial stenosis successfully treated with stenting and discuss the advantages of percutaneous intervention over coronary bypass surgery.
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Eur J Cardiothorac Surg · Mar 2011
Acute kidney injury network classification predicts in-hospital and long-term mortality in patients undergoing elective coronary artery bypass grafting surgery.
Acute kidney injury (AKI) is a highly prevalent complication after cardiac surgery. It is associated with substantial morbidity and mortality. However, the definition of AKI has not been well established until the Acute Kidney Injury Network group outlined an easily used consentaneous staging system. The study aims to evaluate the association between this determination and in-hospital as well as long-term mortality in patients receiving elective coronary artery bypass grafting (CABG) surgery. ⋯ Acute Kidney Injury Network classification is a powerful tool to evaluate the prognostic impact of AKI on both in-hospital and long-term mortality among patients undergoing elective CABG surgery.
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Eur J Cardiothorac Surg · Mar 2011
Multicenter StudyAortic atresia is associated with an inferior systemic, cerebral, and splanchnic oxygen-transport status in neonates after the Norwood procedure.
Aortic atresia (AA) is a risk factor for mortality after the Norwood procedure. The mechanisms remain unknown. We compared the profiles of systemic, cerebral, and splanchnic oxygen transport in neonates with hypoplastic left-heart syndrome with AA or aortic stenosis (AS) after the Norwood procedure. ⋯ AA is associated with an inferior status of systemic, cerebral, and splanchnic oxygen transport after the Norwood procedure. Aggressive use of vasopressin may worsen systemic oxygen transport and decrease splanchnic perfusion.