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 2013
First serial in vivo results of mechanical circulatory support in children with a new diagonal pump.
Mechanical circulatory support (MCS) is a rescue therapy for infants and children suffering from severe cardiorespiratory failure with specific system-related complications like bleeding, thromboembolism and device failure. Novel circuit components for temporary MCS with improved haemodynamic properties may improve patients' outcome and reduce system-related morbidities. The Deltastream DP3 (Medos Medizintechnik AG, Stolberg, Germany) is a newly designed rotational pump with a diagonally streamed impeller that can be used in children of all ages (priming volume 16 ml, flow 0-8 l/min). The aim of this study was to analyse the feasibility and safety of the DP3 pump system in children. ⋯ The use of the Deltastream DP3 seems to be safe and effective for MCS in children and may show a low degree of haemolysis. We observed no system-related complications and an overall good outcome in this demanding patient cohort.
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Eur J Cardiothorac Surg · Nov 2013
Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up single-centre experience.
Since August 2001, the frozen elephant trunk (FET) technique has been used at our institution to treat degenerative or dissecting aneurysms involving the aortic arch and descending aorta as a potential 'single-stage' procedure. The aim of this study was to review our FET experience and to present the 10-year results. ⋯ An FET concept adds to the armament of the surgeon in the treatment of complex and diverse aortic arch pathologies. The preoperative patient risk profile explains the postoperative morbidity and in-hospital mortality. The FET can potentially be still a 'one-stage' procedure in selected patients. However, the extension of FET to patients with extensive aortic aneurysms has led to an increase in second-stage procedures.
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Eur J Cardiothorac Surg · Nov 2013
Five-year follow-up of drug-eluting stents implantation vs minimally invasive direct coronary artery bypass for left anterior descending artery disease: a propensity score analysis.
The spread of drug-eluting stents (DES) has reduced the incidence of early restenosis following percutaneous coronary interventions (PCI). Meanwhile, development of minimally invasive coronary artery bypass surgery (MIDCAB) has offered a valuable alternative to conventional sternotomy with preservation of the benefit of the internal mammary artery use. Therefore, the revascularization of the left anterior descending (LAD) artery is suitable for both techniques. However, few data with long-term comparison of these two techniques exist. ⋯ MIDCAB and DES implantation showed similar rates of survival but despite an expected lower rate of reintervention on the targeted vessel with DES use, a highly significant higher MACCE rate was observed in the PCI group at 5-year follow-up.
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Eur J Cardiothorac Surg · Nov 2013
Phrenic nerve injury after paediatric heart surgery: is aggressive plication of the diaphragm beneficial?
Phrenic nerve injury after paediatric heart surgery is associated with significant morbidity. Surgical plication of the diaphragm is believed to be beneficial to the patient, with difficult weaning from ventilation; however, the optimal timing remains unclear. We aimed to compare the outcome after two different strategies for treating hemidiaphragmatic paresis. ⋯ Changing the strategy for phrenic nerve injury after paediatric heart surgery towards a more aggressive one with early plication of the diaphragm was not associated with the better outcome. Prospective randomized studies are needed to determine the optimal management of this complication.
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The arterial switch operation (ASO) is the method of choice for the Taussig-Bing heart. The aim of the study was to analyse the long-term outcome of correction of the Taussig-Bing heart. ⋯ Corrective surgery offers excellent survival benefits and encouraging long-term functional outcomes, regardless of the coronary anatomy and associated lesions. Normal biventricular function is preserved in the vast majority of patients, and >3/4 of patients are without cardiac medication. Nevertheless, TBH associated with a complex anatomy continues to be a risk factor for long-term morbidity, and redos and reinterventions are equally common on both outflow tracts. Progressive neoaortic regurgitation and neoaortic root dilatation might be a problem in the future; therefore, close lifelong surveillance of patients is necessary.