The Annals of thoracic surgery
-
Postcardiotomy left ventricular failure (LVF) complicating a cardiac surgical procedure is usually managed with intraaortic balloon pump (IABP) counterpulsation. We report two cases of postcardiotomy LVF unresponsive to inotropic support and IABP counterpulsation that were managed successfully with the use of the TandemHeart percutaneous ventricular assist device (pVAD) (CardiacAssist, Pittsburgh, PA). The TandemHeart pVAD appears to be safe and effective as a bridge to recovery in the treatment of postcardiotomy cardiac failure.
-
Extracorporeal membrane oxygenation can provide effective mechanical circulatory support for the failing circulation in children. Patients with failing Fontan and bidirectional Glenn physiology present additional challenges both for extracorporeal membrane oxygenation cannulation and support. We report our institutional experience in patients with cavopulmonary connections who received extracorporeal membrane oxygenation. ⋯ Patients with failing Fontan and bidirectional Glenn physiology present significant challenges to successful extracorporeal membrane oxygenation support. While the morbidity and mortality rates are high, there are select patients for whom extracorporeal support can be effective and lifesaving as a short-term resuscitative intervention.
-
Whether the bidirectional Glenn procedure is better performed without the support of cardiopulmonary bypass is still a matter for debate. In this paper we discuss the indications and methods for bidirectional Glenn shunt without cardiopulmonary bypass. ⋯ The adverse effects of cardiopulmonary bypass could be eliminated by this method. This is an advantage during the postoperative recovery, but patients should be strictly chosen.
-
The encouraging results of valve repair in the atrioventricular valves have influenced a decision about aortic valve (AV) reconstruction. We report our experience with pericardial cusp extension to repair rheumatic AV disease. ⋯ Although AV repair by extension with pericardium is worth considering with an acceptable solution to achieve a good geometry from unequal cusps, especially in young rheumatic patients for preservation of the native AV, the patients should be followed periodically for reoperation risk.
-
Randomized Controlled Trial Clinical Trial
Indicators of atrial fibrillation risk in cardiac surgery patients on prophylactic amiodarone.
Atrial fibrillation is a common complication of cardiothoracic surgery (coronary artery bypass graft surgery or cardiac valve repair or replacement). Although predictors of postoperative atrial fibrillation have been explored in patients not receiving prophylactic antiarrhythmic therapy, independent predictors of postoperative atrial fibrillation in patients receiving prophylactic amiodarone have not been elucidated. ⋯ This subanalysis demonstrates some novel predictors of postoperative atrial fibrillation, including diabetes mellitus and postoperative nonsteroidal antiinflammatory drug use. We have also demonstrated that predictors of atrial fibrillation differ when prophylactic amiodarone is used.