Percutaneous coronary intervention: General principles
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Total circulatory support may be needed in refractory cases. LV assist devices drain blood from the left heart and pump it back into the systemic arterial circulation. The TandemHeart device (Cardiac Assist, Inc, Pittsburgh, PA) is a percutaneously inserted device consisting of a transseptal left atrial inflow catheter and a femoral arterial outflow catheter. The Impella device (Abiomed, Inc, Danvers, MA) operates on a similar principle but is inserted across the aortic valve. Extracorporeal circulatory devices additionally pass the venous blood through a membrane oxygenator, thereby incorporating oxygenation with perfusion support. Although LV assist devices offer superior hemodynamic support over intra-aortic balloon counterpulsation, current data fail to demonstrate a survival difference.[72]
Recognition and Management of the Sick Child
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
There are various subtypes of ECLS (with varying degrees of overlap) including: ECLA – extracorporeal lung-assisted systemsECMO – extracorporeal membrane oxygenation: a high-flow ECLS to replace lung and/or heart function, the term used synonymously with ECLSECCO2R – extracorporeal carbon dioxide removalECPR – extracorporeal cardiopulmonary resuscitation (emergency cardiac support in cardiac arrest). The principle of these techniques is that blood is drained from the circulation and reinfused back after passing through the extracorporeal circuit where it is oxygenated and carbon dioxide is removed.
Venous and lymphatic disease: A historical review
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
On April 18, 1961, Denton Cooley (Figure 1.8) from Houston, Texas, accomplished the first pulmonary embolectomy under extracorporeal circulation in a 37-year-old woman recovering from abdominal hysterectomy.2 However, even with extracorporeal circulation, there continued to be a tremendous risk of mortality secondary to fatal intraoperative embolisms and high rates of rethrombosis.8,21 It remained a measure of last resort reserved only for massive, acute PEs or chronic, recurrent PEs resulting in large thrombi wedged in the pulmonary arteries and causing severe pulmonary hypertension.2 A few years later, in 1969, Dr. Lazar Greenfield suggested a less invasive method of pulmonary embolectomy using a catheter introduced into the femoral vein under fluoroscopic guidance. This technique, known as transvenous catheter embolectomy or thrombo-fragmentation, was associated with a 25% mortality rate and similar indications as open pulmonary embolectomy.2
Preoperative oral methadone for postoperative pain in patients undergoing cardiac surgery: A randomized double-blind placebo-controlled pilot
Published in Canadian Journal of Pain, 2019
Timothy M. Bolton, Sarah O. Chomicki, William P. McKay, D. Ryan Pikaluk, Jeffrey G. Betcher, John C. Tsang
An obvious limitation of our study is its small size; despite this, the data showed a reduction of morphine consumption postoperatively. A second limitation is that high-risk patients and opioid-tolerant patients were excluded from enrollment. It is unclear what effect preoperative oral methadone would have in this group; however, one could speculate that it might show a similar benefit. Due to our small sample size, we only captured two patients with chronic pain and, due to randomization, they both received placebo; however, they did not use significantly more morphine than other patients in the placebo group and therefore did not skew the results. Extracorporeal circulation was used for every patient undergoing coronary artery bypass grafting. Although we know that initiation of cardiopulmonary bypass decreases the plasma concentration of other lipophilic opioids, such as fentanyl (by 53%) and sufentanil (by 34%), separation from cardiopulmonary bypass returns these sequestered narcotics into the systemic circulation of the patient30–32; however, formal pharmacokinetic studies of methadone for comparison are unpublished.
Effects of Isolated Impaired Fasting Glucose on Brain Injury During Cardiac Surgery Under Cardiopulmonary Bypass
Published in Journal of Investigative Surgery, 2020
Tao Zhou, Suining Li, Daokang Xiang, Lufang Gao
After standard sternotomy, the ascending aorta cannula, and upper and inferior venous cannulas were placed. All patients underwent mild hypothermic CPB with intermittent administration of St. Thomas’ Hospital cardioplegic solution. An extracorporeal circulation system (Jostra, Germany) and a membrane oxygenator (Medtronic, USA) were used. The same type of priming solution and blood dilution standards were used during CPB in both groups. The perfusion flow was controlled at 60–70 ml/kg/min. Mean arterial pressure was maintained at 50–80 mmHg. Insulin treatment was performed when the blood glucose concentration was more than 11.1 mmol/l during CPB. Routine treatment was performed postoperatively. Vasoactive drugs were used as appropriate to maintain a stable internal environment and hemodynamics. The duration of CPB and cross-clamp time were recorded. Postoperatively, the time taken to return to consciousness, duration of mechanical ventilation, and duration of stay in the intensive care unit were recorded. Adverse events included common complications of each system. All prognostic endpoints were set to 30 days postoperatively.
Thromboembolic Risk of C1 Esterase Inhibitors: A Systematic Review on Current Evidence
Published in Expert Review of Clinical Pharmacology, 2020
Kevin Burnham, Justin P. Reinert
In the assessment of thrombotic events associated with C1-INHs, studies included in this review demonstrated that the risk of thromboembolism is low. The systematic search criteria particularly selected for articles that included a discussion about thromboembolic risk with C1-INHs, and therefore excluded many studies where no TEEs occurred. Underlying risk factors make it difficult to determine if C1-INH use has a causal link to the events. Certain risk factors are more compelling than others and may aid in deciding if a patient should avoid using these agents. The risk factors that were discussed in the reviewed studies included all of the risk factors found in the C1-INHs package inserts. Other risk factors were also mentioned, such as extracorporeal circulation and venous compression. Patients with multiple baseline risk factors were shown to tolerate these agents without complications. Some studies did not provide enough details regarding dosing or information to assess the impact of patient risk factors in those experiencing a TEE.
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