Journal of cardiac surgery
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The HeartMate 3 left ventricular assist device (LVAD) is a novel, intrapericardial, centrifugal-flow pump with a fully magnetically-levitated rotor designed to provide hemodynamic support in patients with end-stage heart failure. Unique aspects of this LVAD have allowed for improved hemocompatibility and the development of minimally-invasive implantation techniques. ⋯ HeartMate 3 has reduced the rate of disabling stroke and pump thrombosis. However, despite increased hemocompatibility due to specialized design features, the residual risk of both surgical, and gastrointestinal bleeding remains a major adverse outcome. Different anticoagulation management and surgical techniques have been evaluated to address the remaining complications.
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Current guidelines recommend root replacement when diameter of the sinuses of Valsalva are superior to 45 mm particularly for bicuspid valve. However, in case of tubular aorta aneurysms with moderate root dilatation (40-45 mm diameter), the approach is still debated regarding the increased risk of coronary reimplantation. We present a modified hemi-remodeling aortic repair technique that includes the replacement of the noncoronary sinus, ascending aorta, and valve repair with external ring annuloplasty in patients with bicuspid aortic valve (BAV) and moderately dilated aortic root. ⋯ The standardized modified hemi-remodeling technique we present is a safe and reproducible procedure, with satisfactory durability at follow-up. This technique represents an interesting alternative to full valve sparing root replacement, as it avoids the operative risk of coronary reimplantation, allows shorter cross-clamping time and a better exposition on the valve for a symmetrical repair, placing the commissure at 180°, compared with valve sparing root replacement.
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Right ventricular (RV) failure is associated with poor outcome and increased mortality in cardiac surgery. Aim of our study was to analyze the outcome of veno arterial extracorporeal membrane oxygenation (va ECMO) therapy in patients with isolated RV failure in postcardiotomy cardiogenic shock (PCS) and to evaluate risk factors associated with 30-day-mortality. ⋯ ECMO therapy in RV failure due to PCS is shown to be associated with an excessive mortality. Regarding our data, va ECMO might only be an appropriate short-term mechanical assist device separating patients form cardiopulmonary bypass with an acceptable weaning rate. Particularly, in case of failed hemodynamic recovery of the right heart on va ECMO, direct RV bypass systems might function as a bailout option. Additionally, cardiac enzymes and lactic acid might provide valuable information in meeting therapy-related decisions.
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Minimally invasive cardiac surgery (MICS) has expanded during the recent years due to interest in improved patient satisfaction and decreased stay in the hospital. To assist in these interests, postoperative pain control is aimed at decreasing opioid usage but maintaining adequate pain control. Regional anesthesia has the ability to provide these goals. This review article will describe different regional anesthesia techniques and discuss the evidence of their use in MICS. ⋯ As cardiac surgery moves toward smaller incisions and MICS with the goal of enhanced recovery, multimodal analgesic techniques should be explored for postoperative pain control. The regional techniques discussed in this article show a trend toward improved pain control and decreased stay in the intensive care unit.
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Surgical aortic valve replacement (SAVR) is the most common valvular surgery and thus needs to be widely available including minorities and socially disadvantaged patients. SAVR outcomes at safety-net hospitals, which serve a high percentage of these patients, are limited. We aimed to compare the outcomes of SAVR at different safety-net burden hospitals. ⋯ SAVR outcomes are reassuring at MBHs and HBHs.