Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Mechanical support for pulmonary veno-occlusive disease: combined atrial septostomy and venovenous extracorporeal membrane oxygenation.
The use of atrial septostomy for refractory pulmonary hypertension and right ventricular failure results in an adequate left ventricular preload and improved cardiac output at the expense of a profound hypoxic shunt. Combined dual-lumen venovenous extracorporeal membrane oxygenation and atrial septostomy provides extracorporeal gas exchange of venous return before the directional right atrial to left atrial shunt, can be deployed percutaneously, and results in an ambulatory patient with stable hemodynamics.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Beating heart surgery with pulmonary perfusion and ventilation during cardiopulmonary bypass: target organs' perfusion without plegia.
Myocardial and pulmonary ischemia during cardiopulmonary bypass (CPB) is associated with cardiac and pulmonary dysfunction that may result in poor outcomes after cardiac surgery. Beating heart surgery and continuous pulmonary perfusion and ventilation represent emerging strategies targeting the cardiopulmonary bypass-induced ischemia and ischemia-reperfusion injury in susceptible organs--heart and lungs.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Case ReportsHuge ruptured and infected pseudoaneurysm of the ascending aorta and aortic arch with erosion of sternum after previous cardiac surgery.
A 77-year-old woman underwent aortic valve replacement and coronary bypass grafting in 2007 in the Emirates. Evolution was uneventful until December 2011. After repeated episodes of unspecific infections, a computed tomographic scan showed a large pseudoaneurysm of the distal ascending aorta. ⋯ The patient was transferred to our institution. The challenges of this case included safe surgical approach (sternotomy, cannulation, perfusion, cerebral protection) as well as complete removal and extensive debridement of the infected material and reconstruction of the aortic arch. Using fully biological material, reconstruction of the ascending aorta and proximal arch was successfully performed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
The future of tissue-engineered organs for transplant? It's here!
The first-in-man bioengineered artificial tracheobronchial transplant consisting of a synthetic scaffold and autologous bone marrow-derived mesenchymal cells was recently reported. Extensive evaluation of the patient before and after transplant provides some insight into the potential mechanisms of stem cell mobilization and tracheal tissue regeneration.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Cerebral protection for aortic arch surgery: deep hypothermia.
The technical aspects of arch surgery have evolved considerably during the last 2 decades. The use of deep hypothermic circulatory arrest has been embraced by many cardiac surgeons to approach aortic arch aneurysms around the world. The branched graft technique that we have been using since the late 1990s has improved surgical outcomes and simplified the treatment considerably. We describe our technique of total arch replacement by using deep hypothermia and selective cerebral perfusion in aortic arch surgery.