Journal of cardiothoracic and vascular anesthesia
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J. Cardiothorac. Vasc. Anesth. · Dec 2024
Unveiling Baseline Clinical Divergence in VA ECMO vs. ECPELLA: Tailoring Treatment for Distinct Patient Profiles. A Systematic Review and Meta-analysis.
The benefit of combining multiple mechanical circulatory support (MCS) systems in patients with cardiogenic shock (CS) is debated. This review examines patient characteristics across studies to identify differences and assesses if patients with a higher-risk clinical profile receive Impella unloading. ⋯ Patients who received a combination of MCS and VA ECMO have a greater prevalence of comorbidities.
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A circular shunt, initially described by Shone et al. in 1962, refers to abnormal blood recirculation through complete intracardiac or intra- and extracardiac communications, bypassing the capillary beds. This pathophysiological condition is most commonly associated with complex congenital heart defects, such as Ebstein's malformation, pulmonary atresia, Gerbode defect, and so on. ⋯ Diagnosis requires a high index of suspicion and careful evaluation, and its management focuses on interrupting or reducing the shunt through surgical repair or transcatheter intervention or, in some cases, medical therapy. Early diagnosis, particularly in prenatal cases, and timely intervention are crucial for improving outcomes in affected neonates.