The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Complex aortic surgery in a regional center in the United Kingdom. Should the United Kingdom now adopt a United States-style supercenter model?
The United States has established aortic supercenters, which have demonstrated clear improvements in the short-term and long-term outcomes after surgery on the thoracic aorta. This model of care does not exist in the United Kingdom. We have looked at our recent experience of emergency and elective thoracic aortic surgery and describe and compare our operative outcomes and 10-year survival with other regional centers and supercenters worldwide. ⋯ Our outcomes are comparable with other regional centers worldwide; however, they are not as good as those reported from the aortic supercenters. There should be continued impetus regarding the establishment of thoracic aortic surgery guidelines and specialist aortic centers in the United Kingdom.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Extracorporeal membrane oxygenation in patients undergoing superior cavopulmonary anastomosis.
Patients who have undergone the superior cavopulmonary anastomosis (Glenn procedure) have unique cardiopulmonary-cerebral physiology that may limit the success of cardiopulmonary resuscitation and extracorporeal membrane oxygenation (ECMO). Limited data published to date suggest grim morbidity and mortality when ECMO is used. We utilized the Extracorporeal Life Support Organization registry database to more thoroughly assess outcomes in these patients. ⋯ Mortality in infants with Glenn physiology supported with ECMO is lower than that previously reported, but the incidence of neurologic injury is high. These data support use of ECMO in patients with Glenn physiology with refractory cardiopulmonary failure.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Effect of early and intensive continuous venovenous hemofiltration on patients with cardiogenic shock and acute kidney injury after cardiac surgery.
Continuous renal replacement therapy (CRRT) is currently the mainstay renal support for critically ill patients. However, the optimal intensity of CRRT remains debated owing to the heterogeneity of the study populations and CRRT techniques across centers. The present study investigated the beneficial effects of early and intensive continuous venovenous hemofiltration (CVVH) on patients with shock after cardiotomy. ⋯ In patients developing postoperative cardiogenic shock and acute kidney injury after cardiac surgery, an early higher CVVH dose was associated with better in-hospital and long-term survival. Moreover, the beneficial effect of intensive treatment might be more critical in the early perioperative period.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Emergency use of cardiopulmonary bypass in complicated transcatheter aortic valve replacement: importance of a heart team approach.
Transcatheter aortic valve replacement (TAVR) expands options for high-risk patients with aortic stenosis but is complex with life-threatening complications. We describe indications for use of salvage cardiopulmonary bypass (CPB) and assess outcomes. ⋯ Complications during TAVR can be life threatening and may necessitate additional procedures. Expeditious use of CPB support provided by a multidisciplinary heart team optimizes rescue after myocardial collapse.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Age alone should not preclude surgery: contemporary outcomes after aortic valve replacement in nonagenarians.
Advanced age plays a major role in surgical risk algorithms; however, the outcomes data for the very elderly are lacking. We, therefore, evaluated the outcomes after surgical aortic valve replacement (SAVR) in nonagenarians (age, >90 years) at our institution during an 11-year period. ⋯ Excellent procedural and long-term outcomes can be achieved in nonagenarians, and age alone should not be a contraindication to SAVR in selected populations. Our sample cohort has validated the feasibility of a primary operative strategy in elderly patients with aortic stenosis and acceptable risk profiles.