The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs.
Crawford extent II repairs are the most extensive thoracoabdominal aortic aneurysm operations and pose the greatest risk of postoperative spinal cord deficit. We sought to examine spinal cord deficit after open extent II thoracoabdominal aortic aneurysm repair to identify predictors of the most serious type: persistent paraplegia or paraparesis. ⋯ Spinal cord deficit after extent II thoracoabdominal aortic aneurysm repairs remains concerning; survival is worse in patients with persistent paraplegia or paraparesis. The complexity of spinal cord deficit and persistent paraplegia or paraparesis warrant further study.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Normothermic ex vivo lung perfusion: Does the indication impact organ utilization and patient outcomes after transplantation?
Ex vivo lung perfusion (EVLP) is being increasingly applied as a method to evaluate and treat donor lungs for transplantation. However, with the previous limited worldwide experience, no studies have been able to evaluate the impact of indication for EVLP on organ utilization rates and recipient outcomes after lung transplantation (LTx). We examined these outcomes in a large-cohort, single-center series of clinical EVLP cases. ⋯ Clinical implementation of EVLP has allowed our program to expand the annual lung transplantation activity by 70% in this time period. It has improved confidence in the utilization of DCD lungs and BDD lungs, with an average 70% utilization of post-EVLP treated donor lungs with excellent outcomes, while addressing significant challenges in donor lung assessment and the logistics of "real-life" clinical lung transplantation.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
A turbulence in vitro assessment of On-X and St Jude Medical prostheses.
The objective of this study was to investigate and compare the hemodynamic and turbulence characteristics upon implantation of St Jude Medical (SJM) (St Jude Medical, St Paul, Minn) and On-X (On-X Life Technologies, Kennesaw, Ga) bileaflet mechanical valves. Both valves are considered highly successful bileaflet mechanical valves characterized by good clinical outcomes despite their numerous design differences. Although thromboembolism remains the main disadvantage of bileaflet mechanical valves, On-X valves have been shown to need less anticoagulation therapy. ⋯ This study shows that despite the design differences that characterize the On-X valve, the hemodynamic and turbulence parameters were not necessarily improved compared with SJM.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Temporal expression of cytokines and B-cell phenotypes during mechanical circulatory support.
Allosensitization during mechanical circulatory support (MCS) is a well-described phenomenon, although its mechanism remains unknown. Although immune-mediated interactions from devices or blood transfusions have been proposed, the role of inflammation in this development is less clear. This study was undertaken to further investigate the temporal association of cytokines and B-cell phenotypes in the MCS population. ⋯ MCS device implantation was associated with increased inflammatory cytokines and maturation of B-cell phenotypes. No patients developed de novo HLA antibodies, whereas several showed increases in anti-HLA antibody levels detected before implantation. This suggests that inflammation and maturation of existing sensitized B cells might play an important role in the pathogenesis of allosensitization in MCS.