J Cardiothorac Surg
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J Cardiothorac Surg · Aug 2016
Randomized Controlled Trial Multicenter StudyRationale and design of the multicenter randomized trial investigating the effects of levosimendan pretreatment in patients with low ejection fraction (≤40 %) undergoing CABG with cardiopulmonary bypass (LICORN study).
Patients with a left ventricular ejection fraction (LVEF) of less than 40 % are at high risk of developing postoperative low cardiac output syndrome (LCOS). Despite actual treatments (inotropic agents and/or mechanical assist devices), the mortality rate of such patients remains very high (13 to 24 %). The LICORN trial aims at assessing the efficacy of a preoperative infusion of levosimendan in reducing postoperative LCOS in patients with poor LVEF undergoing coronary artery bypass grafting (CABG). ⋯ The usefulness of levosimendan in the perioperative period has not yet been documented with a high level of evidence. The LICORN study is the first randomized controlled trial evaluating the clinical value of preoperative levosimendan in high risk cardiac surgical patients undergoing CABG.
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J Cardiothorac Surg · Aug 2016
Observational StudyAbsence of association between whole blood viscosity and delirium after cardiac surgery: a case-controlled study.
Delirium after cardiothoracic surgery is common and associated with impaired outcomes. Although several mechanisms have been proposed (including changes in cerebral perfusion), the pathophysiology of postoperative delirium remains unclear. Blood viscosity is related to cerebral perfusion and thereby might contribute to the development of delirium after cardiothoracic surgery. The aim of this study was to investigate whether whole blood viscosity differs between cardiothoracic surgery patients with and without delirium. ⋯ In this case control study in cardiothoracic surgery patients changes in whole blood viscosity were not associated with the development of delirium.
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J Cardiothorac Surg · Jul 2016
Case ReportsPulmonary artery agenesis associated with coronary collaterals among adults.
Unilateral agenesis of the pulmonary artery is a rare congenital anomaly, which commonly involves the right side. Cases are associated with systemic collaterals, that may also rarely arise from the coronary arteries. ⋯ The implications of such an anomaly on pulmonary artery pressure and lung pathology differs among both cases. The association of coronary collaterals is rare and its implication is variable among various patients.
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J Cardiothorac Surg · Jul 2016
Case ReportsHeart transplantation as salvage therapy for progressive prosthetic valve endocarditis due to methicillin-resistant Staphylococcus epidermidis (MRSE).
Prosthetic valve endocarditis (PVE) has the highest in-hospital mortality among all cases of infective endocarditis (IE), it is estimated at about 40 %. Orthotopic heart transplantation (OHT) as a measure of last resort, may be considered in selected cases where repeated surgical procedures and conservative efforts have failed to eradicate persistent or recurrent IE. Only few clinical data are available regarding this rare indication for OHT, since active IE has traditionally been considered as a contraindication for OHT. ⋯ PVE remains a challenging condition regarding diagnosis and treatment. The presented case underscores the urgent need for an integrated and multidisciplinary approach to patients with suspected and definitive IE - especially in PVE. OHT might be a feasible measure of last resort in selected patients with IE. Our case report adds published clinical experience to this rarely performed procedure and consolidates previous findings.
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J Cardiothorac Surg · May 2016
Case ReportsCentral extracorporeal membrane oxygenation for treatment of reperfusion oedema following pulmonary thromboendarterectomy: a case report.
One of the most severe and frequent complication of pulmonary thromboendarterectomy is reperfusion pulmonary oedema. The only effective treatment for this complication is extracorporeal membrane oxygenation. A case of successful treatment of reperfusion pulmonary oedema with prolonged veno-arterial extracorporeal membrane oxygenation complicated by several episodes of bleeding and surgical site infection is presented.