Journal of cardiac surgery
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Reliable predictors of myocardial recovery post-mechanical assist device implantation are not well defined. We report the case of a 29-year-old woman with refractory congestive heart failure due to acute myocarditis of unknown etiology. The patient was supported with a HeartMate (Thoratec Corp., Woburn, MI) left ventricular assist device for 100 days showing improvement in clinical status. ⋯ The patient was successfully explanted. This case confirms that myocardial recovery is feasible with the use of a mechanical assist device. This article describes our current left ventricular assist device weaning protocol.
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Retrograde cerebral perfusion (RCP) provides better brain protection than hypothermic circulatory arrest (HCA) alone. The mechanism by which RCP improves brain protection during circulatory arrest remains unknown. The purpose of the study in pigs was to determine if RCP improves brain protection mainly as a result of its ability to maintain cerebral hypothermia. ⋯ In an acute pig model, maintenance of cerebral hypothermia does not appear to be the principal mechanism by which RCP provides better brain protection than HCA alone. Retrograde cerebral perfusion provides nutrient flow/oxygen to brain tissue, leading to better brain protection than HCA alone.
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A 45-year-old female with Marfan syndrome had a Bentall's procedure performed 19 years ago. She presented with a 4-year history of gradually worsening dyspnea and decreasing exercise tolerance. ⋯ The mitral valve was replaced and the aortic aneurysmal sac and the LMSCA aneurysm were then repaired by a modified Bentall procedure. The patient made an uneventful recovery and was discharged home.
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Acute renal failure (ARF) following cardiac surgery remains a significant cause of mortality. The aim of this study is to compare early and intensive use of continuous veno-venous hemodiafiltration (CVVHDF) with conservative usage of CVVHDF in patients with ARF after cardiac surgery. ⋯ Recognition of ARF and early beginning of the CVVHDF are extremely important. The sooner the ARF after surgery is recognized and CVVHDF is performed, the higher the likelihood of the reduction of the hospital mortality.
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There has been an increase in the number of elderly patients considered for cardiac surgery. Several reports have documented acceptable morbidity and mortality in patients 80 years and older. The results from surgical patients 85 years and older were analyzed. ⋯ Cardiac surgery can be performed in patients 85 years and older with good results. There is an associated prolonged hospital stay for elderly patients. Consistent successful outcomes can be expected in this patient population with selective criteria identifying risk factors.