European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2011
Left ventricular assist device or heart transplantation: impact of transpulmonary gradient and pulmonary vascular resistance on decision making.
Fixed pulmonary hypertension is a contraindication for heart transplantation. Left ventricular assist device support may lower it and bridge patients to heart transplantation. The aim of the study was to investigate the optimal parameters for treatment decisions and the time course of their potential reversal to normal values during preoperative inotropic support. ⋯ Transpulmonary gradient and pulmonary vascular resistance, but not mean pulmonary arterial pressure, are predictive parameters for successful heart transplantation in cases of severe postcapillary pulmonary hypertension. When no significant decrease in pulmonary vascular resistance and transpulmonary gradient after 3-4 days of pharmacological therapy is observed, mechanical circulatory support is the only option to bridge end-stage heart failure patients to heart transplantation. Survival after heart transplantation is strictly related to the reversibility of pulmonary vascular resistance and transpulmonary gradient before assist implantation, but not related to mean pulmonary artery pressure.
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Paravalvular leaks still occur following prosthetic valvular replacement. When the leaks are large or are causing symptoms or hemolysis, they require closure. Multiple techniques, including transcatheter interventions, are described in the literature to deal with the problem. This article describes a simple surgical technique that can secure closure of mitral paravalvular leaks in the vicinity of the coronary sinus.
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Eur J Cardiothorac Surg · Mar 2011
Multicenter StudyAortic atresia is associated with an inferior systemic, cerebral, and splanchnic oxygen-transport status in neonates after the Norwood procedure.
Aortic atresia (AA) is a risk factor for mortality after the Norwood procedure. The mechanisms remain unknown. We compared the profiles of systemic, cerebral, and splanchnic oxygen transport in neonates with hypoplastic left-heart syndrome with AA or aortic stenosis (AS) after the Norwood procedure. ⋯ AA is associated with an inferior status of systemic, cerebral, and splanchnic oxygen transport after the Norwood procedure. Aggressive use of vasopressin may worsen systemic oxygen transport and decrease splanchnic perfusion.
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Eur J Cardiothorac Surg · Mar 2011
ReviewTraining and assessment of technical skills and competency in cardiac surgery.
The assessment of surgical competency has become a priority for both surgical educators and licensing boards. Surgical educators must incorporate rigorous, reliable, and valid means of assessment into residency programs. Objective evaluation of technical skills has been extensively explored in various surgical specialties, but its role in cardiac surgery has not been well studied and there is limited experience with integration into the educational curricula. ⋯ Most of the available models have not been well validated or integrated into educational curricula. The cardiac surgery simulation tools in development need validation and incorporation into structured, competency-based training curricula. The ongoing development of surgical simulators and educational curricula will enable a transition from the century-old graded responsibility training program to a competency-based program, where trainees must demonstrate technical competence to progress to the next level of training and gain certification and re-certification--ultimately ensuring better and faster technical skill acquisition as well as improved quality of care and patient safety.
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Eur J Cardiothorac Surg · Mar 2011
Use of donors who have suffered cardiopulmonary arrest and resuscitation in lung transplantation.
Shortage of donors is one of the major limitations in lung transplantation (LuTX) and an aggressive expansion of criteria for donor selection has been proposed. This study evaluates the outcome of recipients of pulmonary grafts coming from resuscitated donors when compared with recipients of non-resuscitated donors. ⋯ This study indicates that transplantation of lungs from resuscitated donors may not affect outcome after LuTX. Therefore, donor history of CA should not automatically preclude LuTX.