Journal of cardiac surgery
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Case Reports
Impella LP 2.5 for left ventricular unloading during venoarterial extracorporeal membrane oxygenation support.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is commonly used as a means of support for acute cardiopulmonary failure. In the setting of severe left ventricular (LV) dysfunction, VA-ECMO may be complicated by LV distension, which can lead to pulmonary edema and compromise myocardial recovery. ⋯ We report the use of the Impella LP 2.5 for LV decompression in a 70-year-old man with decompensated heart failure who was placed on VA-ECMO for cardiogenic shock with severe pulmonary edema and respiratory failure. Both devices were successfully weaned on day 5 of VA-ECMO support, after myocardial recovery.
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Comparative Study
Midterm outcomes of off-pump and on-pump coronary artery revascularization in renal transplant recipients.
Renal transplant recipients have high mortality from cardiac causes and are frequently in need of coronary interventions. Surgical coronary revascularization is associated with significant morbidity and mortality in this patient population. This study was undertaken to evaluate outcomes of on-pump versus off-pump revascularization in renal transplant recipients. ⋯ Despite higher mortality risk, surgical coronary revascularization can be performed safely in renal transplant recipients. OPCAB resulted in no improvement in patient survival or renal allograft function compared to on-pump revascularization.
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A 60-year-old femalepresented with progressive dysphagia and was found to have a right-sided aortic arch with external posterior compression of the upper esophagus due to severe compression from a Kommerell's diverticulum with an aberrant left subclavian artery. This patient underwent division of the diverticulum with an aorto-subclavian graft implantation under femoro-femoral bypass and recovered uneventfully. A review of the literature and discussion of the surgical management is presented.
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Comparative Study
Is body mass index a risk factor for isolated off-pump coronary revascularization?
The influence of body mass index (BMI) as a risk factor for isolated off-pump coronary artery bypass (OPCAB) surgery is unknown. We postulated that BMI ≥ 30 kg/m(2) would adversely affect outcomes following OPCAB at our institution. ⋯ Obesity does not influence operative characteristics or effect outcomes after OPCAB. BMI ≥ 30 kg/m(2) should not be considered a prohibitive risk factor in isolated off-pump coronary revascularization.
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Valve deterioration following aortic valve replacement using the Freestyle stentless bioprosthesis is related to cusp tear, operative injury, or infection. We report a patient with aortic regurgitation due to perforation of the right coronary cusp 10 years after implantation of a Freestyle stentless bioprosthesis in the absence of endocarditis.