The Annals of thoracic surgery
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Cardiopulmonary bypass is associated with an inflammatory response with potential deleterious effects. The white cell subpopulation mostly investigated so far is the neutrophil. To date very little has been investigated regarding the role of the monocyte/macrophage. This study focuses on the expression of Fc gamma receptors I, II, and III by monocytes in patients undergoing cardiopulmonary bypass. ⋯ Our study demonstrated that cardiopulmonary bypass is associated with a biphasic Fc gamma receptor III expression on a subpopulation of peripheral blood monocytes up to 3 days postoperatively.
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Bridging to transplant with a left ventricular assist device (LVAD) can be limited by severe right ventricular failure (RVF). The focus of this study was to ascertain whether early implantation (< 24 hours) of a right ventricular assist device (RVAD) in patients with severe RVF improved survival and whether severe RVF adversely affected post-transplant survival. ⋯ Severe RVF adversely impacted bridging to transplant, although survival was improved with early RVAD insertion. The trend toward worse post-transplant survival in the RVAD cohort raises the possibility that if additional patients were evaluated, a difference in survival might be observed, suggesting the need for a multicenter analysis.
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Inadequate data exist regarding the management of acute major pulmonary embolism. Various modalities that are used, including thrombolytics and embolectomy, have not been shown to conclusively improve mortality when compared to heparin. In the past, open pulmonary embolectomy was reserved for patients with severe hemodynamic instability because of its high mortality rate. Our objective was to analyze our experience with early embolectomy as an alternative for the treatment of major pulmonary embolism. ⋯ Open pulmonary embolectomy can be performed in patients with major pulmonary embolism with minimal mortality and morbidity. It may prevent the development of chronic thromboembolic pulmonary hypertension and should be a part of the algorithm in the treatment of major pulmonary embolism.
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In recent years, percutaneous tracheostomy (PCT) has become a routine practice in many hospitals. In the early publications, most authors considered adverse conditions such as short or fat neck or obesity as relative contraindications, whereas cervical injury and emergency were regarded as absolute contraindications. More recently, several reports demonstrated the safety and feasibility of PCT in patients with some of the above contraindications. We, like many others, gradually reduced the contraindications and expanded the indications for PCT. In this paper, we report our early experience with emergency PCT in trauma patients. ⋯ Emergency PCT using a modified Griggs' technique is feasible and safe. In experienced hands, it might be even easier and faster than the open surgical tracheostomy.