European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jun 2011
Extracorporeal membrane oxygenation as perioperative right ventricular support in patients with biventricular failure undergoing left ventricular assist device implantation.
Left-ventricular assist device (LVAD) implantation complicated by early right ventricle (RV) failure has a poor prognosis. This study details our center's experience with veno-arterial extracorporeal membrane oxygenation (ECMO) as perioperative RV support in patients with preoperative biventricular failure undergoing LVAD implantation. ⋯ ECMO provided a satisfactory perioperative right-heart support in patients with preoperative biventricular failure undergoing LVAD implantations, who otherwise were better candidates for biventricular assist device. ECMO allowed time for the already compromised right ventricle to get attuned to the increasing preload, and avoids distension and RV failure.
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Eur J Cardiothorac Surg · Jun 2011
Comparative StudyTransapical aortic valve replacement under real-time magnetic resonance imaging guidance: experimental results with balloon-expandable and self-expanding stents.
Aortic valves have been implanted on self-expanding (SE) and balloon-expandable (BE) stents minimally invasively. We have demonstrated the advantages of transapical aortic valve implantation (tAVI) under real-time magnetic resonance imaging (rtMRI) guidance. Whether there are different advantages to SE or BE stents is unknown. We report rtMRI-guided tAVI in a porcine model using both SE and BE stents, and compare the differences between the stents. ⋯ SE stents were easier to position and deploy, thus leading to fewer complications during tAVI. Future optimization of SE stent design should improve clinical results.
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Eur J Cardiothorac Surg · Jun 2011
Multicenter StudyAn Australian risk prediction model for determining early mortality following aortic valve replacement.
To develop a multivariable logistic risk model for predicting early mortality following aortic valve replacement (AVR) in adults, and to compare its performance against existing AVR-dedicated models. ⋯ Existing AVR-dedicated risk models were deemed inappropriate for risk prediction in the Australian population. A preoperative risk model was developed using prospective data from a contemporary AVR cohort.
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Eur J Cardiothorac Surg · Jun 2011
ReviewInformed consent for interventions in stable coronary artery disease: problems, etiologies, and solutions.
The objective of this review was to determine whether patients undergoing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (1) understand the aims of the proposed intervention, and (2) whether they are offered alternative and potentially more effective therapies, as required for the process of informed consent. We performed a systematic review of Medline for observational studies of patient understanding and perceptions of coronary revascularization and of the consent process. Data extraction was of patient perceptions of expected symptomatic and prognostic benefits of PCI and CABG, and the proportion of patients offered potential alternative treatments. ⋯ Moreover, patients are frequently not offered potentially more effective alternative therapies. This raises important questions about the adequacy of the current informed consent process. We recommend a multidisciplinary team approach as the most obvious way to remedy current practice.
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Despite the efficacy of cardiac surgery, less invasive interventions with more uncertain long-term outcomes are increasingly challenging surgery as first-line treatment for several congenital, degenerative and ischemic cardiac diseases. The specialty must evolve if it is to ensure its future relevance. More importantly, it must evolve to ensure that future patients have access to treatments with proven long-term effectiveness. ⋯ The demands of a modern surgical career and the importance of the task at hand are such that the serendipitous emergence of traditional charismatic leadership cannot be relied upon to deliver necessary change. We advocate systematic analysis and strategic leadership at a local, national and international level in four key areas: Clinical Care, Research, Education and Training, and Stakeholder Engagement. While we anticipate that exceptional individuals will continue to shape the future of our specialty, the creation of robust structures to deliver collective leadership in these key areas is of paramount importance.