The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jul 1988
Isolated left ventricular assist as bridge to cardiac transplantation.
The electrically driven Novacor implantable left ventricular assist device has been implanted in six patients (four men and two women) since Sept. 7, 1984. In four of the six patients (67%) the device was a successful bridge to cardiac transplantation. One patient died of multiple organ failure and Candida sepsis after 16 days of support with the device. ⋯ No embolic events (cerebrovascular or systemic) occurred during assistance with the device. Minimal red cell hemolysis was documented during the period of support. The Novacor left ventricular assist device is a safe and effective bridge to cardiac transplantation in patients with refractory cardiogenic shock.
-
J. Thorac. Cardiovasc. Surg. · Jul 1988
A new reconstructive operation for Ebstein's anomaly of the tricuspid valve.
Ebstein's anomaly is a complex malformation involving the tricuspid valve and the right ventricle. Various surgical techniques, either repair or replacement of the abnormal tricuspid valve, have been used with variable results. In an attempt to enlarge the indications of conservative procedures, we developed a technique of repair that comprises the reconstruction of a normally shaped right ventricle and the repositioning of the tricuspid valve at the normal level. ⋯ There were two hospital deaths and no late deaths in this series. All surviving patients displayed a marked improvement over their preoperative status with regard to functional class (92% are in class I or II) and rhythm disturbances. Echocardiographic and Doppler studies demonstrated a normal shape of the right ventricle and good tricuspid valve function in all the patients but one.
-
Thymectomy has been shown to be effective in the treatment of myasthenia gravis. The logical goal of operation has been complete removal of the thymus, but there has been controversy about the surgical technique and its relation to results. Surgical-anatomic studies have shown gross and microscopic thymus widely distributed in the neck and mediastinum. ⋯ The response in group C was also less good than in group A and proportionately fewer benefited. These results support the recommendation for thymectomy in the treatment of patients with generalized myasthenia gravis and indicate the desirability of a maximal procedure. For persistent or recurrent severe symptoms after previous transcervical or submaximal transsternal resections, reoperation by this technique is also recommended.
-
J. Thorac. Cardiovasc. Surg. · May 1988
Ventricular septal defects and arteriovenous fistulas, with and without valvular lesions, resulting from penetrating injury of the heart and aorta.
Thirty-one patients with post-traumatic intracardiac shunts or arteriovenous fistulas were treated surgically in the past 8 years. All patients had had penetrating injuries of the heart, ascending aorta, or aortic arch 1 week to 4 years earlier, but only three had an early emergency operation. Eleven patients (35%) had ventricular septal defects and seven (23%) had other types of intracardiac fistulas. ⋯ The remaining 29 patients were alive and well when last seen, with no signs of residual shunt and with good valve function. The high prevalence of late complications necessitates routine investigation of patients with penetrating injuries of the heart and the aorta. Surgical correction carries a low mortality and morbidity and is advised in all patients with symptoms.
-
J. Thorac. Cardiovasc. Surg. · May 1988
Comparative StudyCoronary bypass grafting after failed elective and failed emergent percutaneous angioplasty. Relative risks of emergent surgical intervention.
Emergency coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty can be performed with acceptable complication rates. Recently, however, a new class of patients with unsuccessful angioplasty has evolved with the use of thrombolytic therapy and emergent angioplasty as treatment for developing acute myocardial infarction. The efficacy of surgical intervention after failure of angioplasty in this setting has not been demonstrated. ⋯ Six patients in group II (15.6%) required reexploration for bleeding, versus none in group I (p = 0.04). Nonhemorrhagic complication rates, mean in-patient and acute care days, total hospital charges, and blood product utilization rates were not statistically different. These data indicate that emergency coronary artery bypass grafting can be performed when necessary in the setting of failed emergent percutaneous transluminal coronary angioplasty with results comparable to coronary bypass after failed elective angioplasty.