ABSTRACT
Reopening the chest in patients with left ventricular assist devices at the time of a heart transplant is challenging due to adhesions and the possibility of injury to vital structures. The sternal sparing bilateral thoracotomy approach utilized to implant a left ventricular assist device minimizes the chances of such injuries and offers a cosmetically better outcome. We demonstrate a procedure for implanting a left ventricular assist device in a 54-year-old man diagnosed with dilated cardiomyopathy who suffered rapid decompensation despite maximum medical therapy.
Subject(s)
Heart Failure , Heart-Assist Devices , Heart Failure/surgery , Humans , Male , Middle Aged , Prosthesis Implantation , Sternum , Thoracotomy , Treatment OutcomeABSTRACT
OBJECTIVES: The true impact of postoperative blood pressure (BP) control on development of aortic regurgitation (AR) following continuous-flow left ventricular assist device (CF-LVAD) implantation remains uncertain. This study examines the influence of BP in patients with de novo AR following CF-LVAD implantation. METHODS: All patients with no or Subject(s)
Aortic Valve Insufficiency/epidemiology
, Blood Pressure/physiology
, Heart-Assist Devices/adverse effects
, Adult
, Female
, Humans
, Male
, Middle Aged
, Postoperative Period
, Retrospective Studies
, Risk Factors
ABSTRACT
Left ventricular assist device (LVAD) is now a routine therapy for advanced heart failure. Authors demonstrate a novel technique of LVAD implantation through a single left thoracotomy with anastomosis of outflow graft to the arch of aorta. The technique avoids sternotomy or additional right thoracotomy, keeps ascending aorta clear and puts outflow graft away from the sternum.
Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Prosthesis Implantation/methods , Thoracotomy/methods , Humans , Male , Middle AgedABSTRACT
The availability of donor organs is the biggest limitation for lung transplantation, and a significant proportion of patients die on the waiting list. We describe a case of a 44-year-old lady who developed subarachnoid hemorrhage and cerebral edema on second postoperative day after left ventricular assist device implantation. She was declared brain stem dead 2 days later, and her organs were transplanted to suitable recipients on the waiting list for lung, liver and kidney transplantation.
Subject(s)
Brain Death , Brain Edema/etiology , Heart Failure/therapy , Heart-Assist Devices/adverse effects , Subarachnoid Hemorrhage/etiology , Tissue Donors/supply & distribution , Tissue and Organ Harvesting , Ventricular Function, Left , Adult , Brain Edema/diagnosis , Fatal Outcome , Female , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Kidney Transplantation , Liver Transplantation , Lung Transplantation , Prosthesis Design , Subarachnoid Hemorrhage/diagnosis , Time FactorsABSTRACT
OBJECTIVES: Ticagrelor (Brilique®) is a novel reversible platelet inhibitor at P2Y12 receptor used in patients with acute coronary syndrome and patients undergoing percutaneous coronary interventions. Unlike clopidogrel (Plavix®), ticagrelor has a quicker offset of action, and therefore, it seems that platelet function recovers faster on discontinuation of therapy. These drugs sometimes cannot be stopped before coronary artery bypass grafting due to the risk of stent thrombosis or in case of emergency operations. Therefore, we investigated whether the continued preoperative use of ticagrelor influences the perioperative course of cardiac surgical patients. METHODS: The perioperative course and clinical outcomes of patients preoperatively receiving ticagrelor + acetylsalicylic acid (ASA) (n = 32) or clopidogrel + ASA (n = 49) until cardiac surgery, performed at University of Goettingen between January 2012 and December 2012, were studied. The study was designed as a retrospective observational study. The observation period started with the surgery and ended after 3 days. P < 0.05 was considered statistically significant. RESULTS: Preoperative data and intraoperative characteristics were almost similar among the groups. In the first 24 h, the median blood loss was 850 [780-1600] ml in the ticagrelor group and 680 [400-860] ml in the clopidogrel group (P = 0.0006). Furthermore, the median red blood cell transfusion (P = 0.0031), the median pooled platelet transfusion (P = 0.0012), the median prothrombin complex concentrate use (P = 0.0114) and the median fibrinogen use (P = 0.0118) were significantly higher in the ticagrelor group compared with the clopidogrel group. However, there was no statistical significance between the two groups regarding intensive care unit and hospital stay, mechanical ventilation time, incidence of acute kidney injury and mortality. Hence, a tendency towards more rethoracotomies due to bleeding in the ticagrelor group was observed (P = 0.0632). CONCLUSIONS: In cardiac surgical patients who are treated with ticagrelor + ASA until surgery, ticagrelor therapy is associated with a significantly higher blood loss, a significantly higher use of blood products and coagulation factors and higher incidence of rethoracotomies for bleeding compared with patients treated with clopidogrel + ASA.
Subject(s)
Adenosine/analogs & derivatives , Coronary Artery Bypass/statistics & numerical data , Perioperative Period/statistics & numerical data , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/therapeutic use , Adenosine/administration & dosage , Adenosine/adverse effects , Adenosine/therapeutic use , Aged , Aged, 80 and over , Aspirin/administration & dosage , Aspirin/adverse effects , Aspirin/therapeutic use , Blood Transfusion/statistics & numerical data , Female , Hemorrhage , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Retrospective Studies , Ticagrelor , Treatment OutcomeABSTRACT
Pulmonary blastoma is a rare primary lung neoplasm, in that monophasic variety is far too rare. There are no specific clinical features seen for pulmonary blastoma; computed tomography and histopathology are diagnostic. Surgical excision is the treatment of choice; however, adjuvant chemotherapy and radiotherapy may be required in large and aggressive tumors.
Subject(s)
Lung Neoplasms/diagnosis , Lung Neoplasms/surgery , Pulmonary Blastoma/diagnosis , Pulmonary Blastoma/surgery , Adolescent , Biopsy , Chemotherapy, Adjuvant , Diagnosis, Differential , Diagnostic Imaging , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Pulmonary Blastoma/drug therapy , Pulmonary Blastoma/pathology , ThoracotomyABSTRACT
Diseased, replaced or repaired mitral valve can lead to restricted blood flow to left ventricle and inadequate flow in left ventricular assist device (LVAD). A middle age woman with 'burnt out' hypertrophic cardiomyopathy had mitral valve repair for mitral regurgitation. She needed LVAD to support severe decompensating heart failure. Repaired mitral valve posed a risk of restricted flow through the device. Mitral commissurotomy was performed on beating heart through the left ventricular apical hole created for insertion of inflow cannula of LVAD.
Subject(s)
Cardiomyopathy, Hypertrophic/surgery , Heart Failure/surgery , Heart-Assist Devices , Mitral Valve Insufficiency/surgery , Adult , Cardiomyopathy, Hypertrophic/diagnostic imaging , Cardiomyopathy, Hypertrophic/physiopathology , Diagnosis, Differential , Echocardiography , Female , Heart Failure/diagnostic imaging , Heart Failure/physiopathology , Humans , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , SternotomyABSTRACT
The prevalence of myocardial involvement in influenza infection ranges from 0% to 12%. The 2009 pH1N1 influenza virus, formerly known as swine flu, first appeared in Mexico and the United States of America in March and April 2009 and has swept the globe with unprecedented speed. We report a case of fulminant myocarditis associated with this virus treated successfully using extra-corporal membrane oxygenator.
