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 2015
The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience†.
We aimed to evaluate the long-term prognosis of prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD). ⋯ The FET technique results in excellent aortic remodelling of the downstream aorta and can improve the long-term outcomes for AAAD.
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Eur J Cardiothorac Surg · Feb 2015
Older age at the time of the Norwood procedure is a risk factor for early postoperative mortality†.
The Norwood procedure is commonly used as first-step palliation in children with hypoplastic left heart syndrome or related congenital malformations. In most cases, the operation is carried out during the first week of life. Excessive pulmonary blood flow in univentricular physiology can soon lead to compromised cardiac function and pulmonary hypertension and could have an influence on postoperative outcomes. ⋯ Age older than 20 days seems to be an independent risk factor for early postoperative mortality and fatal events after the Norwood procedure. Long-persisting excessive pulmonary blood flow and preoperative cardiac decompensation can be the reason for postoperative lethal pulmonary hypertensive crisis and compromised ventricular function.
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Eur J Cardiothorac Surg · Jan 2015
Elective use of femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation.
Elective use of normothermic cardiopulmonary bypass (CPB) may reduce the risks associated with the transcatheter aortic valve implantation (TAVI) procedure in selected high-risk TAVI patients. ⋯ The use of preoperatively planned CPB may increase the safety of the TAVI procedure in patients with severely reduced heart function or in cardiogenic shock.
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Eur J Cardiothorac Surg · Jan 2015
Multicenter StudyNational review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation.
Extracorporeal membrane oxygenation (ECMO) for respiratory support is increasingly used in intensive care units (ICU), but rarely during thoracic surgical procedures outside the transplantation setting. ECMO can be an alternative to cardiopulmonary bypass for major trachea-bronchial surgery and single-lung procedures without in-field ventilation. Our aim was to evaluate the intraoperative use of ECMO as respiratory support in thoracic surgery: benefits, indications and complications. ⋯ VV or VA ECMO is a satisfactory alternative to in-field ventilation in complex tracheo-bronchial surgery or in single-lung surgery. ECMO should be considered and used in precarious postoperative respiratory conditions. Full respiratory support can be achieved with VV ECMO. Indications for and results of ECMO during surgery in patients with ARDS warrant further careful investigation.
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Eur J Cardiothorac Surg · Jan 2015
Recovery of donor hearts after circulatory death with normothermic extracorporeal machine perfusion.
A severe donor organ shortage leads to the death of a substantial number of patients who are listed for transplantation. The use of hearts from donors after circulatory death could significantly expand the donor organ pool, but due to concerns about their viability, these are currently not used for transplantation. We propose short-term ex vivo normothermic machine perfusion (MP) to improve the viability of these ischaemic donor hearts. ⋯ Our results indicate that functional recovery from global WI is possible during short-term ex vivo reperfusion, allowing subsequent cold storage without compromising organ viability. We expect that once refined and validated, this approach may enable safe transplantation of hearts obtained from donation after circulatory death.