European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2015
Isolated permanent right ventricular assist device implantation with the HeartWare continuous-flow ventricular assist device: first results from the European Registry for Patients with Mechanical Circulatory Support.
Isolated right ventricular (RV) dysfunction with preserved left ventricular function is difficult to treat and associated with high mortality. Temporary devices for right ventricular support [right ventricular assist device (RVAD)] are available and have been used for short-term right heart assistance. In some patients, RV function does not recover and long-term devices are needed. Recently, isolated RVAD implantation with a permanent HeartWare HeartWare ventricular assist device (HVAD) device has been reported in patients with acute RV infarction and chronic graft failure. However, isolated implantation on the right side remains rare and is still an off-label use for this pump. To gather European data, we queried the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) database, in which procedures and outcome data for patients receiving mechanical circulatory support are registered. ⋯ In this very specific and sick patient cohort within the EUROMACS registry, isolated permanent RVAD implantation is a novel and promising strategy for patients with isolated right heart failure. However, more experience is needed to identify patients who benefit from this technology.
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Eur J Cardiothorac Surg · Jul 2015
Meta AnalysisErythropoietin administration for prevention of cardiac surgery-associated acute kidney injury: a meta-analysis of randomized controlled trials.
The effect of erythropoietin (EPO) on the prevention of cardiac surgery-associated acute kidney injury (CSA-AKI) is controversial. Therefore, we undertook the meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of EPO on the prevention of CSA-AKI in adult patients and to explore whether risk factors for AKI could explain the inconsistent effects. PubMed and EMbase databases were searched to identify eligible RCTs. ⋯ EPO administration could significantly reduce the incidence of CSA-AKI, but not in patients with high risk factors for AKI. Substantial heterogeneity across trials could be attributed to high risk factors for AKI. However, our findings should be interpreted cautiously because of the limited studies included, and high-quality RCTs are warranted.
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Eur J Cardiothorac Surg · Jul 2015
Comparative StudyAcute type A aortic dissection: characteristics and outcomes comparing patients with bicuspid versus tricuspid aortic valve.
The aim of this study is to investigate the clinical characteristics and postoperative outcome of patients with a bicuspid aortic valve (BAV) suffering acute dissection in comparison with their tricuspid peers. ⋯ Patients with BAV have a distinctive dissection pattern with the entry tear frequently located in the aortic root and-despite their younger age-are subject to substantial hospital mortality. For bicuspid patients suffering from dissection, composite root replacement yields an excellent outcome equal to an age- and gender-matched normal population.
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Eur J Cardiothorac Surg · Jul 2015
Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study.
Residual right ventricular outflow tract (RVOT) obstruction (RVOTO) is considered beneficial in patients after repair of tetralogy of Fallot (TOF) although underlying mechanisms are unknown. We sought to elucidate differences in myocardial strain and dyssynchrony parameters in patients after TOF repair with and without residual RVOTO using cardiovascular magnetic resonance (CMR) feature-tracking (CMR-FT) analysis. ⋯ In patients after TOF repair, residual RVOTO seems to preserve RV strain and results in stronger RV-LV interactions and less interventricular dyssynchrony and may therefore possess an early protective effect on RV remodelling. However, the potential negative impact of residual pulmonary stenosis on LV strain and intraventricular synchrony needs further investigation.
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Eur J Cardiothorac Surg · Jul 2015
Clinical outcomes of combined aortic root reimplantation technique and total arch replacement.
The goal of this study was to evaluate early and late outcomes of combined valve-sparing aortic root replacement and total arch replacement (TAR). ⋯ Early outcomes of combined aortic root reimplantation and TAR were satisfactory and provided excellent freedom from thromboembolic complication. The rate of freedom from reoperation during long-term follow-up was acceptable. Further follow-up is required to evaluate this procedure.