European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2015
Total aortic arch replacement with frozen elephant trunk in acute type A aortic dissections: are we pushing the limits too far?†.
Acute type A aortic dissection (AADA) is a surgical emergency. In patients with aortic arch and descending aorta (DeBakey type I) involvement, performing a total aortic arch replacement with frozen elephant trunk (FET) for supposedly better long-term results is controversial. We hereby present our results. ⋯ Our results with FET in AADA show acceptable results. Total aortic arch replacement with an FET in AADA patients does demand high technical skills. In spite of this, we believe FET improves long-term outcomes in cases of AADA with intima tear or re-entry in the aortic arch or the descending aorta (DeBakey type I). Modern grafts with four side branches as well as sewing collars for the distal anastomosis have helped to further 'simplify' the FET implantation. However, such a strategy is not appropriate in all AADA cases; it should be implemented only in experienced centres and only if absolutely necessary.
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Eur J Cardiothorac Surg · Feb 2015
The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience†.
We aimed to evaluate the long-term prognosis of prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD). ⋯ The FET technique results in excellent aortic remodelling of the downstream aorta and can improve the long-term outcomes for AAAD.
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Eur J Cardiothorac Surg · Jan 2015
Multicenter StudyNational review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation.
Extracorporeal membrane oxygenation (ECMO) for respiratory support is increasingly used in intensive care units (ICU), but rarely during thoracic surgical procedures outside the transplantation setting. ECMO can be an alternative to cardiopulmonary bypass for major trachea-bronchial surgery and single-lung procedures without in-field ventilation. Our aim was to evaluate the intraoperative use of ECMO as respiratory support in thoracic surgery: benefits, indications and complications. ⋯ VV or VA ECMO is a satisfactory alternative to in-field ventilation in complex tracheo-bronchial surgery or in single-lung surgery. ECMO should be considered and used in precarious postoperative respiratory conditions. Full respiratory support can be achieved with VV ECMO. Indications for and results of ECMO during surgery in patients with ARDS warrant further careful investigation.
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Eur J Cardiothorac Surg · Jan 2015
New indicator of postoperative delayed awakening after total aortic arch replacement.
Impact of the decrease of regional cerebral oxygen saturation (rSO2) on postoperative delayed awakening after total aortic arch replacement (TAR) was validated. ⋯ The maintenance of rSO2 at the early phase of rewarming may be important to avoid delayed awakening or TND after TAR.
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Eur J Cardiothorac Surg · Jan 2015
Extracorporeal membrane oxygenation as a bridge to lung transplantation: a long-term study.
We investigated early outcomes in patients with end-stage pulmonary disease bridged with extracorporeal membrane oxygenation (ECMO) with the intention to perform lung transplantation (LTx). ⋯ ECMO used as a bridge to LTx results in acceptable survival in selected patients with end-stage pulmonary disease.