Journal of cardiac surgery
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Transaortic transcatheter aortic valve implantation (TAo-TAVI) has been recently proposed as an alternative to transapical (TA) and transfemoral (TF) approach. We now discuss a technical issue associated with TAo-TAVI related to the use of a delivery system dedicated to the antegrade TA approach. The potential solutions to this issue as well as the potential advantages of the TAo approach are discussed.
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Anticoagulation with heparin is recommended in patients with an intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in the early postoperative period after cardiac surgery. We investigated the safety of heparin-free management after IABP insertion in patients who underwent cardiac surgery. ⋯ In patients undergoing cardiac surgery with IABP support, the rate of thromboembolic complications was relatively low compared to historical controls. Heparin-free management may reduce the risk of hemorrhagic complications, with a low risk of thrombotic complications. Heparin should not be routinely used in patients requiring IABP after cardiac surgery.
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Lung hernia is an uncommon diagnosis characterized by lung tissue protruding through a chest wall defect. It may occur spontaneously, as a congenital defect, as a result of trauma, or as a postsurgical complication. We describe the occurrence of lung hernia and subsequent successful herniorraphy in two patients following robotic-assisted mitral valve repair.
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Acute refractory cardiogenic shock with early multisystem organ failure has a poor outcome without mechanical circulatory support. We review our experience with emergent peripheral cardiopulmonary support as a bridge to decision in these patients. ⋯ Salvage peripheral cardiopulmonary support is a useful tool to rapidly stabilize acute refractory cardiogenic shock permitting an assessment of neurologic and end-organ viability.
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Apical and midventricular hypertrophic cardiomyopathy (HCM) are rare variants of HCM, in which the hypertrophy is located mainly at the midventricular to apical levels. Heart transplantation was the only possible surgical solution for many of these patients; however, transapical myectomy represents another good alternative. We present our surgical technique of apical ventriculotomy for apical and midventricular myectomy. ⋯ The transapical approach provides excellent exposure of the apex and midventricle, and the technique is useful when myectomy is aimed at eliminating the ventricular obstruction and/or enlarging the left ventricular cavity size in patients with apical hypertrophy.