Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 4 de 4
Filter
1.
JTCVS Open ; 16: 450-459, 2023 Dec.
Article in English | MEDLINE | ID: mdl-38204642

ABSTRACT

Objective: To determine the characteristics and outcomes of patients requiring prolonged (>90 days) venovenous extracorporeal membrane oxygenation (VV ECMO) support for refractory Coronavirus disease 2019 (COVID-19)-associated respiratory failure. Methods: A retrospective, observational analysis of consecutive patients requiring VV ECMO for COVID-19-associated respiratory failure was performed at a single institution between March 2020 and January 2022. Data were collected from the medical records. Patients were predominantly cannulated and supported long-term with a single, dual-lumen cannula in the internal jugular vein with the tip positioned in the pulmonary artery. All patients were managed with an awake VV ECMO approach, emphasizing avoidance of sedatives, extubation, ambulation, physical therapy, and nutrition. Patients requiring >90 days of ECMO were identified, analyzed, and compared to those needing a shorter duration of support. Results: A total of 44 patients were supported on VV ECMO during the study period, of whom 36 (82%) survived to discharge. Thirty-one patients were supported for <90 days, of whom 28 (90%) were discharged alive. Thirteen patients required >90 days of ECMO. All patients were extubated. Eight patients (62%) survived to discharge, with 1 patient requiring lung transplantation prior to decannulation. All survivors were free from mechanical ventilation and alive at a 6-month follow-up. Of the 4 patients who died on prolonged ECMO, 2 developed hemothorax necessitating surgery and 2 succumbed to fatal intracranial hemorrhage. Conclusions: Patients treated with VV ECMO for COVID-19-associated respiratory failure may require prolonged support to recover. Extubation, ambulation, aggressive rehabilitation, and nutritional support while on ECMO can yield favorable outcomes.

2.
Congenit Heart Dis ; 5(6): 629-34, 2010.
Article in English | MEDLINE | ID: mdl-21106026

ABSTRACT

Congenitally corrected transposition of the great arteries (ccTGA) accounts for less that 1% of cardiac anomalies, and is defined as ventriculoarterial and atrioventricular (AV) discordance. The double discordant connection allows for survival with the right ventricle performing as the systemic ventricle, and the left ventricle as the pulmonary ventricle. We report a case of ccTGA in a 35-year-old male with situs inversus totalis status post repair of a ventricular septal defect (VSD) with a residual VSD, severe systemic AV valve regurgitation, and coronary artery disease who presented with chest pain. He subsequently underwent tricuspid valve replacement and VSD repair, followed by percutaneous coronary revascularization. This case highlights many important issues of adults with congenital cardiac disease, as well as the specific surgical management of anomalies associated with ccTGA. We review the literature and discuss the management of these complicated patients.


Subject(s)
Abnormalities, Multiple , Coronary Stenosis/complications , Tricuspid Valve Insufficiency/complications , Adult , Angina Pectoris/etiology , Angioplasty, Balloon, Coronary , Atrioventricular Block/etiology , Atrioventricular Block/therapy , Cardiac Pacing, Artificial , Congenitally Corrected Transposition of the Great Arteries , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Electrocardiography , Heart Septal Defects, Ventricular/complications , Heart Septal Defects, Ventricular/surgery , Heart Valve Prosthesis Implantation , Humans , Male , Situs Inversus/complications , Situs Inversus/diagnostic imaging , Tomography, X-Ray Computed , Transposition of Great Vessels/complications , Transposition of Great Vessels/diagnostic imaging , Treatment Outcome , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/surgery
3.
J Card Surg ; 25(4): 442-54, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20487107

ABSTRACT

Postcardiotomy cardiogenic shock (PCCS) complicates 0.2% to 6% of cardiac operations and is a clinical entity fraught with considerable morbidity and mortality. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. In the interim, newer technologies have entered the clinical arena. Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center.


Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart-Assist Devices , Postoperative Complications/surgery , Shock, Cardiogenic/surgery , Cardiopulmonary Bypass/instrumentation , Cardiotonic Agents/therapeutic use , Equipment Design , Extracorporeal Membrane Oxygenation/instrumentation , Humans , Hydrazones/therapeutic use , New York , Pyridazines/therapeutic use , Shock, Cardiogenic/drug therapy , Shock, Cardiogenic/etiology , Simendan , Time Factors
4.
J Card Surg ; 25(3): 352-6, 2010 May.
Article in English | MEDLINE | ID: mdl-20331479

ABSTRACT

BACKGROUND: The HeartMate II (HMII) Left Ventricular Assist System (Thoratec Corporation, Pleasanton, CA, USA), an axial continuous-flow left ventricular assist device (LVAD), has been approved for use in bridge-to-transplant patients and is under investigation for destination therapy. To avoid device-related thromboembolic complications, antiplatelet, and anticoagulation therapy are routinely administered. A worrisome frequency of gastrointestinal (GI) bleeding events has been observed. METHODS: A retrospective review of all 33 patients undergoing long-term LVAD implantation between June 1, 2006 and July 31, 2008 at our institution for any indication was conducted. Anticoagulation consisted of heparin (intravenous or subcutaneous) followed by transition to Coumadin therapy to a target INR of two to three. Antiplatelet therapy consisted of low-dose aspirin and dipyridamole. RESULTS: Twenty patients received the HMII and 13 patients received other devices. Eight (40%) HMII recipients suffered at least one episode of GI bleeding while no GI bleeding occurred in recipients of other devices (p = 0.012). Of 17 total bleeding episodes, no definitive source could be identified in 11 instances (65%). CONCLUSIONS: Although definitive source identification remains elusive, we believe that the majority of bleeding arises in the small bowel, possibly due to angiodysplasias, similar to the pathophysiology encountered in patients with aortic stenosis and GI bleeding. As we move toward wider use of the HMII and other axial continuous-flow devices in both bridge-to-transplant patients and for destination therapy, more studies will be necessary to understand the mechanisms of this obscure GI bleeding and develop treatment strategies to minimize its development.


Subject(s)
Gastrointestinal Hemorrhage/etiology , Heart Ventricles , Heart-Assist Devices/adverse effects , Anticoagulants/adverse effects , Aspirin/adverse effects , Dipyridamole/adverse effects , Female , Gastrointestinal Hemorrhage/chemically induced , Heparin/adverse effects , Humans , Incidence , International Normalized Ratio , Male , Middle Aged , Platelet Aggregation Inhibitors/adverse effects , Retrospective Studies , Risk Factors , Warfarin/adverse effects
SELECTION OF CITATIONS
SEARCH DETAIL
...