European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Dec 2011
Implications of acute kidney injury after heart transplantation: what a surgeon should know.
Data regarding risks and consequences of acute kidney injury (AKI) after cardiac transplantation are dismissingly few and unclear. This study defined the incidence, risk factors and prognostic implication of AKI in a single-center cohort operated on between January 1999 and December 2008. ⋯ AKI is a highly prevalent and prognostically important complication. Some of the risk factors for AKI identified may be modifiable.
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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.