J Cardiovasc Surg
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Cardiac tamponade is an uncommon complication of blunt chest trauma, resulting typically from hemorrhage into the pericardial space. We report a case of hemodynamic compromise secondary to an extrapericardial compression caused by the acute formation of a retrosternal hematoma associated with a sternal fracture. The patient was involved in a violent deceleration accident. ⋯ Surgical evacuation of the retrosternal hematoma related to a bifocal fracture of the manubrium was followed by instantaneous hemodynamic improvement. Regional extrapericardial tamponade secondary to the acute formation of compressive retrosternal hematoma is an unusual cause of circulatory failure after severe blunt chest trauma. Since conventional clinical signs associated with typical tamponade physiology may be lacking in this setting, echocardiography is ideally suited for early recognition of this unusual condition.
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The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. ⋯ Increasing age, shock, coronary artery disease and renal failure are variously associated to a high risk of in-hospital death after surgical correction of type A aortic dissection. This predictive model of death probability allows to collocate preoperatively patients with type A aortic dissection at different levels of risk for in-hospital death.
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Clinical Trial Controlled Clinical Trial
Conventional and conventional plus modified ultrafiltration during cardiac surgery in high-risk congenital heart disease.
This prospective nonrandomized study is the critical assessment of conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) techniques and their efficiency in congenital heart disease surgeries. Use of cardiopulmonary bypass (CPB) in children is associated with body water retention as a consequence of prime volume and systemic inflammatory reaction. The CUF during CPB has reduced body water excess and the MUF after CPB, removes inflammatory mediators, improves hemodynamic performance, and decreases transfusion requirements. ⋯ CUF and CUF+MUF were safe and efficient methods for patient stabilization independent of diagnosis and complexity of surgery. Future clinical evaluation should address a larger population of patients to research the different variables.
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Extracorporeal membrane oxygenation (ECMO) provides an immediate support for acute deterioration of hemodynamic and pulmonary status, but what is the best decision for these critical patients? Biventricular assist device (BVAD) or left ventricular assist device (LVAD)? We proposed a protocol of step-by-step conversion from ECMO to LVAD after assurance of the reversibility of right ventricle and pulmonary function. ⋯ The protocol did provide a good guideline for decision-making for those under ECMO support necessitating bridge to transplantation.
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Surgical treatment of proximal aortic disease currently offers a variety of surgical options. Traditionally, replacement of the proximal aorta has been performed with a composite graft in most cases; supracommissural aortic replacement was the only alternative if preservation of the native aortic valve was attempted. Valve-preserving root operations currently allow us to avoid the disadvantages of prosthetic heart valves and completely eliminate aortic root pathology. ⋯ Using current techniques of valve preserving surgery, combined disease of the aortic valve, root, and extended segments of the aorta can be corrected without the disadvantages of prosthetic heart valves in the majority of patients. Further experience will define the relative role of the different operative modifications.