European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2010
Extracorporeal membrane oxygenation for refractory cardiogenic shock after cardiac surgery: predictors of early mortality and outcome from 51 adult patients.
Extracorporeal membrane oxygenation (ECMO) offers temporary haemodynamic support for those with refractory cardiogenic shock after cardiac surgery. We review our 5-year experience regarding ECMO use on those who cannot be weaned from cardiopulmonary bypass after cardiac surgery. We analyse our cases, predict the prognostic factors of survival and compare the short-term and medium-term results. ⋯ ECMO provides a good temporary cardiopulmonary support in patients with postcardiotomy shock. The preoperative risk factors of failure to withdraw ECMO are poor left-ventricular ejection fraction, systolic blood pressure <90 mmHg and refractory severe metabolic acidosis. The peri-ECMO predictors of mortality include low serum albumin level, low platelet count, low oxygen pressure of the venous tube of the ECMO and poor cardiac systolic function.
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Eur J Cardiothorac Surg · Feb 2010
Does video-assisted thoracoscopic lobectomy for lung cancer provide improved functional outcomes compared with open lobectomy?
We evaluated video-assisted thoracic surgery (VATS) and open (OPEN) lobectomy for lung cancer and impact upon 6-month postoperative (postop) functional health status and quality of life. ⋯ VATS lobectomy for curative lung cancer resection appears to provide a superior functional health recovery compared with OPEN techniques.
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Eur J Cardiothorac Surg · Feb 2010
The impact of afterload reduction on the early postoperative course after the Norwood operation - a 12-year single-centre experience.
The objective of this study was to analyse the postoperative course and early outcome after the Norwood operation for patients with hypoplastic left heart syndrome. We particularly aimed to assess the impact of surgical and pharmacological modifications introduced. ⋯ Adamant afterload reduction improves systemic blood flow early after the Norwood operation and may have contributed to the reduction in early postoperative mortality achieved over 12 years.
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Eur J Cardiothorac Surg · Feb 2010
Hypersensitivity reactions to aprotinin re-exposure in paediatric surgery.
Hypersensitivity to aprotinin is low (1-3%) but more likely with re-exposure. The manufacturer issued a black box warning which lists aprotinin re-exposure within 1 year of prior exposure as a contraindication. We investigated the temporal relationship between re-exposure interval and hypersensitivity in children. ⋯ The incidence and type of hypersensitivity to aprotinin re-exposure in our cohort is consistent with previous reports. Repeat exposure within 1 year did not increase the risk of systemic hypersensitivity.
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Eur J Cardiothorac Surg · Jan 2010
Cardiopulmonary bypass with physiological flow and pressure curves: pulse is unnecessary!
Advocates of pulsatile flow postulate that the flow pattern during extracorporeal circulation (ECC) should be similar to the physiological one. However, the waveforms generated by clinically used pulsatile pumps are by far different from the physiological ones. Therefore, we constructed a new computer-controlled pulsator which can provide nearly physiological perfusion patterns during ECC. We compared its effect (group 1) with pulsatile (group 2) and non-pulsatile (group 3) perfusion generated by a conventional roller pump. ⋯ Even when using pulsatile flow patterns which mimic closely the physiological waveforms, there is no advantage concerning organ perfusion or inflammatory response. Moreover, the extent of haemolysis and capillary leak is higher compared to non-pulsatile perfusion. Efforts to optimise pulsatility are not justified.