European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2012
Descending aortic aneurysmal changes following surgery for acute DeBakey type I aortic dissection.
The aim of the study was to determine the risk factors for descending aortic aneurysmal changes following surgery for acute DeBakey type I aortic dissection. ⋯ The proximal descending aorta was the major site of aneurysm formation following surgery for acute type I aortic dissection. The large proximal descending aortic diameter on initial CT predicted the late aneurysm, suggesting that adjunctive procedures combined with aortic replacement are needed to prevent the late aneurysm.
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Eur J Cardiothorac Surg · Nov 2012
Early experiences with miniaturized extracorporeal life-support in the catheterization laboratory.
Cardiocirculatory arrest during different types of interventions in the catheterization laboratory (cath-lab) requires mechanical cardiopulmonary resuscitation (CPR) to restore spontaneous circulation. However, mechanical chest compression leads to interruption of the procedure and can severely compromise the success of the percutaneous coronary intervention (PCI) or transcatheter aortic valve implantation (TAVI). Alternatives to mechanical chest compression are rare and mostly uncommon. The use of extracorporeal assistance for cardiopulmonary resuscitation (E-CPR) can be life-saving, but, up to now, it is not commonly and rapidly available in hospitals with cardiac-catheter laboratories but without cardiac-surgery departments. Here, we report our early experiences in using miniaturized extracorporeal membrane oxygenation (ECMO) systems for E-CPR in the cath-lab. We characterize the emergency uses and the bridging function of these simplified ECMO devices. ⋯ Miniaturized ECMO systems can be safe and highly effective in restoring circulation and gas exchange in patients with cardiocirculatory failure in the cath-lab. Additionally, the PCI and TAVI procedures can be finished successfully on ECMO, otherwise the patients can be bridged to cardiac surgery. Especially for patients in need of cardiac surgery, patient transfer to extracorporeal assistance can be more easily processed.
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Eur J Cardiothorac Surg · Nov 2012
Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients.
The aim of this retrospective study was to assess pre- and intraoperative factors leading to neurological complications and early death following repair of acute type A aortic dissection (ATAAD). ⋯ Regardless of standardized neuroprotective techniques, treatment of ATAAD remains a high-risk operation. Preoperatively, the presence of a reduced ejection fraction, a malperfusion syndrome or a high body mass index may increase the perioperative risk for an adverse outcome. A dissection 'entry' localized in the aortic arch or the descending aorta may increase the risk for postoperative stroke. Intraoperatively, cannulation of the femoral artery and extension of the LBI time over 45 min should be avoided. Especially in patients with manifest preoperative cerebral and/or end-organ malperfusion, the cannulation modality as well as the entire neuroprotective management should be chosen individually, respecting its limitations.
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Eur J Cardiothorac Surg · Nov 2012
Risk of late aortic events after an isolated aortic valve replacement for bicuspid aortic valve stenosis with concomitant ascending aortic dilation.
The optimal surgical treatment of patients with bicuspid aortic valve (BAV) disease and ascending aortic aneurysm is controversial. The aim of this study was to evaluate the risk of late aortic events after an isolated aortic valve replacement (AVR) for BAV stenosis with concomitant mild-to-moderate proximal aortic dilation. ⋯ BAV patients with aortic valve stenosis and concomitant mild-to-moderate ascending aortic dilation are at a considerably low risk of adverse aortic events at 15 years after an isolated AVR. The BAV phenotype should be considered when determining the risk of subsequent adverse aortic events and the need for concomitant aortic replacement.
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Eur J Cardiothorac Surg · Nov 2012
Midterm outcomes of patients undergoing aortic valve replacement after previous coronary artery bypass grafting.
Redo cardiac surgery for aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is technically challenging and carries a high incidence of peri-operative complications. However, experience in the field continues to evolve generating reproducible, and increasingly safer results. We anticipate an increased future role for catheter-based valve procedures and review our operative results to maintain current surgical outcomes for comparison. ⋯ Low initial operative mortality suggests that surgery is safe and reproducible. However, older age and multiple comorbidities in this patient population may significantly influence late outcomes. The data reported in this study: (i) support open surgical technique as a safe, reliable approach for redo AVR in patients who have undergone previous CABG, and (ii) add to the large body of evidence suggesting that STS scores overestimate risk.