European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2017
Multicenter StudyExtended versus limited arch replacement in acute Type A aortic dissection.
The recommended extent of surgical resection and reconstruction of the arch in acute DeBakey Type I aortic dissection is an ongoing controversy. However, several recent reports indicate a trend towards a more extensive arch operation in several institutions. We have analysed the recent data from the International Registry of Acute Aortic Dissection to assess the choice of procedure over time and to evaluate the surgical outcome in a 'real-world' database. Our aim was to compare short- and mid-term outcomes of limited repairs versus complete arch surgery. ⋯ Selective, or 'surgeon's choice', extended arch replacement had no discernible acute downside compared with less extensive surgery. Whether extended arch replacement improves the prognosis beyond 5 years remains to be settled.
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Eur J Cardiothorac Surg · Dec 2017
Comparative StudyImpact of minimally invasive extracorporeal circuits on octogenarians undergoing coronary artery bypass grafting. Have we been looking in the wrong direction?
Minimally invasive extracorporeal circuits (MiECCs) aim at the preservation of physiologic reserves, the impact of which is expected to be most evident in patients in whom these are depleted. In this context, octogenarians present a subpopulation of specific interest. ⋯ The MiECC concept has shown its benefits regarding both morbidity and mortality in this high-risk patient population. We believe that this beneficial effect finds its reason in a better preservation of physiologic reserves that are essential for a positive outcome in this patient group.
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Eur J Cardiothorac Surg · Dec 2017
Comparative StudyMinimally invasive CentriMag ventricular assist device support integrated with extracorporeal membrane oxygenation in cardiogenic shock patients: a comparison with conventional CentriMag biventricular support configuration.
We recently developed a novel minimally invasive surgical approach that combines extracorporeal membrane oxygenation and CentriMag ventricular assist device (Ec-VAD) for the treatment of cardiogenic shock as a short-term circulatory support. We compared the outcomes of this new approach to conventional CentriMag biventricular assist device (BiVAD) support through a median sternotomy. ⋯ Ec-VAD is a unique approach for the treatment of patients in cardiogenic shock. It eliminates the need for cardiopulmonary bypass and reduces blood product utilization and bleeding events.
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Eur J Cardiothorac Surg · Dec 2017
Concomitant repair for mild aortic insufficiency and continuous-flow left ventricular assist devices.
Aortic insufficiency (AI) after continuous-flow left ventricular assist device (CF-LVAD) implantation has become a highly relevant subject. However, management of pre-existing mild AI is unknown. We examined the fate of pre-existing mild AI during CF-LVAD support. ⋯ AI progression among CF-LVAD-supported patients with baseline mild AI is highly prevalent. Baseline aortic root diameter may help identify patients with 'borderline' AI lesion needing repair at device insertion.