European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2017
Impact of failed mitral valve repair on hospital outcome of redo mitral valve procedures.
The prognostic impact of failed mitral valve repair (FMR) on in-hospital outcome after redo mitral valve surgery has not been thoroughly investigated. ⋯ A failed mitral repair does not impact hospital outcome of redo surgery. Given the role of severe left ventricular dysfunction and advanced age on hospital mortality rates, an early indication for redo surgery may improve outcome.
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Eur J Cardiothorac Surg · May 2017
Functional evaluation before lung resection: searching for a low technology test in a safer environment for the patient: a pilot study.
Stair climbing is considered the first step for functional evaluation of patients requiring anatomical lung resection who have low-predicted postoperative forced expiratory volume in the first second of expiration (FEV1) or diffusing capacity of the lungs for carbon monoxide (DLCO) values. Nevertheless, stair climbing is not performed in many centres because of structural issues or patient safety concerns. We hypothesized that comparable exercise can be obtained on an ergometric bicycle in a safer environment where any adverse event can be treated. We tried to correlate the amount of exercise performed by stair climbing and by using an ergometric bicycle in a series of patients with non-small-cell lung cancer (NSCLC) evaluated prospectively. ⋯ This simple test on an ergometric bicycle shows a high correlation with the widely accepted stair-climbing test when workload results are corrected using the patient's age. It could replace the stair-climbing test and has the advantage of being conducted in an environment that is safer for the patient. Nevertheless, its reliability for risk prediction needs to be adequately evaluated.
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Eur J Cardiothorac Surg · May 2017
First series of left ventricular assist device exchanges to HeartMate 3.
Left ventricular assist device (LVAD) exchange is becoming a standard surgical procedure. The exchange procedure is an opportunity to upgrade patients to a new generation pump that offers advanced reduction of adverse events or longer battery hours. ⋯ LVAD exchanges from HM II as well from HVAD to HM 3 are proven to be technically feasible. Due to the advantages and technical improvements of the new-generation pumps, this procedure is an excellent opportunity to give patients access to a superior generation of assist device.
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Eur J Cardiothorac Surg · May 2017
Hypoplastic left heart syndrome: a novel surgical strategy for small-volume centres?
We describe in a prospective study, a novel surgical technique for the management of hypoplastic left heart syndrome inspired by the hybrid Norwood approach. ⋯ This new surgical palliative approach to hypoplastic left heart syndrome, particularly useable technically, seems to combine the advantages of the hybrid procedure by avoiding cardiac ischaemia and ventriculotomy without the complications of PDA stenting and restrictive atrial septectomy. Although the mortality rate decreased significantly, it remains substantial in small-volume centres, especially in the interstage period.
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Eur J Cardiothorac Surg · May 2017
Case ReportsLow dose bivalirudin anticoagulation for lung transplantation with extracorporeal membrane oxygenation in a patient with acute heparin-induced thrombocytopenia.
A patient scheduled for lung transplantation needed veno-venous extracorporeal membrane oxygenation (ECMO) and developed acute heparin-induced thrombocytopenia (HIT). After 21 days on ECMO support, lung transplantation was successfully performed using veno-arterial ECMO with bivalirudin anticoagulation. The target activating clotting time values of 160-180 s resulted in low bivalirudin infusion rates of 0.1 mg/kg/h. Diffuse bleeding stopped quickly after ending the continuous bivalirudin infusion.