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
A heart transplant is the gold standard treatment for end stage heart failure. Preservation of the donor heart during its transfer from the hospital of the donor to that of the recipient has a significant impact on the outcome of the transplant procedure. Icebox storage is a conventional method utilized for this purpose that may not provide uniform cooling of the donor heart and does not allow monitoring of the temperature of the donor heart during preservation. The Paragonix SherpaPak Cardiac Transport System offers uniform cooling by suspending the donor heart in a preservation solution and provides continuous temperature monitoring.
Subject(s)
Organ Preservation/instrumentation , Cold Temperature , Heart Transplantation , HumansABSTRACT
Ex vivo lung perfusion is an indispensable tool in the armamentarium of any lung transplant center. It helps to increase an already shrinking donor pool by offering a chance to assess suboptimal donor lungs in a systematic manner and improve them by treating them with low-molecular-weight perfusate. We offer a stepwise guide to carry out ex vivo lung perfusion on the donor lungs and criteria to accept them for transplants.
Subject(s)
Donor Selection/methods , Extracorporeal Circulation/methods , Lung Transplantation , Lung/physiology , Organ Preservation/methods , Perfusion/methods , Humans , Lung/pathology , Lung/physiopathology , Male , Middle Aged , Tissue DonorsABSTRACT
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) serves as a conventional short-term mechanical circulatory assist to support heart and lung functions. The short-term ventricular assist devices (ST-VAD) can, on the contrary, offer only circulatory support. A combination of VAD and oxygenator (Oxy-VAD) could help overcome this potential disadvantage. This is a retrospective case note study of patients supported on ST-VAD which required adding an oxygenator for extra respiratory support. The oxygenator was introduced in the ST-VAD circuit, either on the left or the right side. Twenty-two patients with the etiology of refractory cardiogenic shock in decompensation were supported on Oxy-VAD between years 2009 and 2019 at tertiary care . All patients were classified into class-I INTERMACS with a mean SOFA Score of 14 ± 2.58. 86.4% of patients were already on mechanical support pre-ST-VAD implant, 80% on VA-ECMO. The BiVAD implant accounted for 63.6%, followed by LVAD and RVAD with 27.3% and 9.1%. Mean duration of the ST-VAD was 8.5 days. The oxygenator was introduced in 14 RVAD and 8 LVAD circuits. The oxygenator was successfully weaned in 54.5% while ST-VAD was explanted in 31.8%. Discharge to home survival was 22.7%. Oxy-VAD proves a viable, and probably, a better option to VA-ECMO in acute cardiorespiratory decompensation. It offers organ-specific tailor-made support to the right and/or left heart and/or lungs. While on Oxy-VAD support, each organ performance can be assessed independently, and the assistance of the specifically improved organ can be weaned off without discontinuing the support for the rest.
Subject(s)
Cardiopulmonary Resuscitation/instrumentation , Heart Failure/therapy , Heart-Assist Devices , Oxygenators , Respiratory Insufficiency/therapy , Adult , Aged , Cardiopulmonary Resuscitation/methods , Female , Heart Failure/complications , Heart Failure/diagnosis , Humans , Male , Middle Aged , Organ Dysfunction Scores , Prospective Studies , Respiratory Insufficiency/complications , Respiratory Insufficiency/diagnosis , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: A prospective study of 50 patients of trauma was carried out at a tertiary level trauma center in Mumbai. The aim was to study the hypermetabolic response to trauma and the effect of early enteral feeding and nutritional supplementation in blunting this response in these patients. METHODS: Early enteral feeding was started within 72 h in most patients. The caloric requirement was calculated as per the body weight and a 150: 1 ratio of nonprotein calories to protein was maintained. A 24-h urinary nitrogen loss was estimated and nitrogen balance was calculated on days 1, 3 and 7. RESULTS: The correlation between the injury severity and the severity of catabolism was also analysed. Urinary nitrogen loss and nitrogen balance were used as parameters to evaluate the hypermetabolic response. CONCLUSIONS: Early (within 72 h) enteral nutritional support blunts this hypermetabolic response to some extent in these trauma patients.
