European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2011
Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection.
The aimed to describe the frozen elephant trunk (FET) technique and partial remodeling (PR) for acute type A aortic dissection (ATAAD), considering the long-term prognosis on the basis of our 13 years of experience. ⋯ FET and modified PR techniques could be effective for improving the long-term outcome on the distal and proximal aorta in an ATAAD.
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Eur J Cardiothorac Surg · Nov 2011
The effectiveness of high-flow regional cerebral perfusion in Norwood stage I palliation.
Regional cerebral perfusion (RCP) has been shown to provide cerebral circulatory support during Norwood procedure. In our institution, high-flow RCP (HFRCP) from the right innominate artery has been induced to keep sufficient cerebral and somatic oxygen delivery via collateral vessels. We studied the effectiveness of HFRCP to regional cerebral and somatic tissue oxygenation in Norwood stage I palliation. ⋯ Our study revealed that HFRCP preserved sufficient cerebral and somatic tissue oxygenation during the Norwood procedure. The reduction of vascular resistance of collateral vessels increased both cerebral and somatic blood flow, resulting in improved tissue oxygen delivery.
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Eur J Cardiothorac Surg · Nov 2011
The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure.
Optimisation of Norwood physiology, with focus on systemic perfusion, has beneficial effects on haemodynamic stability and perioperative mortality following the Norwood procedure for hypoplastic left heart syndrome. Early identification of high-risk patients during the postoperative phase might allow for institution of alternative management strategies with the possibility of avoiding poor outcome. Several studies have suggested that arterial blood lactate level, as an index of systemic perfusion and oxygen delivery, can to some extent predict mortality following paediatric cardiac surgery, though these studies have included heterogeneous groups of patients with only few Norwood patients. We sought to determine whether the blood lactate profile could be used to derive a simple, clinically applicable decision algorithm to direct therapy in a pre-emptive manner and perhaps identify patients for elective extracorporeal life support following the Norwood procedure. ⋯ We have identified minimum blood lactate level within the first 24h after the Sano-Norwood procedure as a highly discriminatory predictor of perioperative mortality. These patients might benefit from elective institution of early mechanical circulatory support.
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Endobronchial valves are increasingly used as a treatment modality as a less invasive alternative to lung volume reduction surgery in patients with severe emphysema. Endobronchial valves have also been used to treat patients with persistent pulmonary air leaks and those with bronchopleural fistulae. ⋯ We inserted two endobronchial valves (in the lingular lobe and the anterior segment of the upper lobe) and the air leak ceased immediately. However, over the subsequent 5 months following the insertion of the endobronchial valves, the patient suffered recurrent chest infections and the endobronchial valves were found to have migrated to the orifice of the basal segment of the left lower lobe and the orifice of the basal segments of the right lower lobe.
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Eur J Cardiothorac Surg · Nov 2011
Re-operations on the proximal thoracic aorta: results and predictors of short- and long-term mortality in a series of 174 patients.
The aim of this study was to report results and to identify predictors of hospital and long-term mortality in patients undergoing re-operations on the proximal thoracic aorta. ⋯ Short- and long-term survival was satisfactory being excellent in patients with degenerative aneurysms and dismal in those with active endocarditis. Extensive aortic resections did not increase hospital mortality and were associated with a reduced need for aortic re-interventions. CPB time remains the most important risk factor for reduced survival in aortic surgery.