Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting...Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.展开更多
Objective To investigate the clinical outcomes of children with congenital heart disease （CHD） requiring extracorporeal membrane oxygenation （ECMO） and left ventricular assist device （LVAD） support after cardiac...Objective To investigate the clinical outcomes of children with congenital heart disease （CHD） requiring extracorporeal membrane oxygenation （ECMO） and left ventricular assist device （LVAD） support after cardiac surgery. Methods A total of 22 patients with CHD who required postcardiotomy mechanical circulatory support between March 2004 and March 2011 （85 months ） were analyzed retrospectively. Median age of the patients was 420 d （ 15 d - 4 years） and median weight was 3.4 kg （ 2 - 14. 5 kg ）. Eight patients were put on ECMO, while 14 patients were placed on LVAD. Results Thirteen （59%） patients died and 9 （41% ） survived to discharge. In survivals, the duration of LVAD and the duration of ECMO were both shorter than those of nonsurvivals （P 〈 O. 05）. The main complication was bleeding. Conclusion The earlier treatment and application of more advanced cardiac support devices for CHD patients are key factors for reducing complications.展开更多
Cardiogenic shock(CS)is a complex clinical syndrome with a high mortality rate.It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous.Acute myocardial infarction-relat...Cardiogenic shock(CS)is a complex clinical syndrome with a high mortality rate.It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous.Acute myocardial infarction-related CS(AMI-CS)has historically been the most prevalent cause,and thus,research and guidance have focused primarily on this.Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission.There is,however,a paucity of data and guidelines to inform the management of these patients who fall into two broad groups:those with existing heart failure and CS and those with no known history of heart failure who present with"de novo"CS.The use of temporary mechanical circulatory support(MCS)has expanded across all etiologies,despite its high cost,resource intensity,complication rates,and lack of high-quality outcome data.Herein,we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis,right ventricular(RV)failure,Takotsubo syndrome,post-partum cardiomyopathy,and CS due to valve lesions and other cardiomyopathies.展开更多
Heart transplantation(HTx)is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first succe-ssful transplant in 1967.The introduction of cyclosporine ...Heart transplantation(HTx)is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first succe-ssful transplant in 1967.The introduction of cyclosporine in the 1970s significantly improved patient outcomes,leading to a global increase in transplants,including in India,where the practice has grown despite initial challenges.This review pro-vides an extensive overview of HTx,focusing on current practices,technological advancements,and the ongoing challenges the field faces today.It explores the evolution of surgical techniques,such as minimally invasive and robotic-assisted procedures,and the management of posttransplant rejection through tailored immunosuppressive strategies,including new monoclonal antibodies and perso-nalized therapies.The review also highlights emerging innovations such as mechanical circulatory support devices and xenotransplantation as potential solutions to donor shortages while acknowledging the ethical and logistical challenges these approaches entail.Furthermore,the analysis delves into the implications of using extended-criteria donors and the role of multidisciplinary teams in evaluating absolute and relative contraindications.Despite the progress made,the persistent issues of organ scarcity and ethical concerns underscore the need for ongoing research and innovation to further enhance the efficacy,safety,and accessibility of HTx.展开更多
BACKGROUND Acute and extreme insulin resistance with persistent hyperglycemia requiring excessively high doses of insulin before rapidly resolving is rare and has been referred to as transient and extreme insulin resi...BACKGROUND Acute and extreme insulin resistance with persistent hyperglycemia requiring excessively high doses of insulin before rapidly resolving is rare and has been referred to as transient and extreme insulin resistance(TEIR).The underlying pathophysiology and optimal management of TEIR are poorly understood,and previous reports of TEIR in the literature are sparse.This report is the first description of TEIR in a patient requiring mechanical circulatory support(MCS).CASE SUMMARY A 62-year-old male developed cardiogenic shock and was placed on veno-arterial extracorporeal membrane oxygenation following percutaneous coronary intervention and successful revascularization.Over the next 24 hours,glucose levels rose and remained markedly elevated despite increasing insulin infusion rates and repeated boluses.The insulin infusion rate peaked at 450 units/hour,and the patient received 4300 units(33 units/kg)of insulin over the 24-hour period of peak insulin resistance.Insulin resistance resolved rapidly,necessitating an abrupt decrease in the insulin infusion rate and development of rebound hypoglycemia.CONCLUSION Onset of TEIR did not seem to correlate with end-organ hypoperfusion or vasoactive drug dosing.展开更多
Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are...Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are commonly encountered in the intensive care unit(ICU).Conditions such as acute respiratory distress syndrome,pulmonary embolism,and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure.In the ICU,RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload,excessive afterload,and/or insufficient myocardial contractility,often in addition to mechanical ventilation and circulatory compromise.This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology.Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup,hemodynamic monitoring,and resuscitative efforts.This narrative review will provide an overview of common conditions associated with RV failure in critical illness,highlighting a practical,physiology-oriented approach to diagnosis and optimization of ventilator support,fluid resuscitation,vasopressor and inotrope use,and mechanical circulatory support.RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities.These conditions require distinct treatment approaches and are beyond the scope of this review.展开更多
While biventricular assist devices(BiVADs)remain underutilized in Western countries for biventricular heart failure(BHF),their application is expanding in China.This consensus synthesizes international guidelines,medi...While biventricular assist devices(BiVADs)remain underutilized in Western countries for biventricular heart failure(BHF),their application is expanding in China.This consensus synthesizes international guidelines,medical evidence,and Chinese clinical expertise to establish standardized protocols for BiVAD management.Key recommendations include:(1)Preoperative right heart catheterization and echocardiography for central venous pressure(CVP):pulmonary capillary wedge pressure(PCWP)ratio and pulmonary artery pulsatility index(PAPi)assessment(Class I);(2)BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device(LVAD)implantation(Class IIa);(3)Right atrial implantation as the preferred surgical approach(Class IIa);(4)Warfarin-based anticoagulation(INR 2.0–2.5)with aspirin,avoiding direct oral anticoagulants(DOACs)(Class III).The guidance addresses critical gaps in patient selection,pump speed titration,and complication management,positioning integrated BiVAD systems as a promising solution for complex BHF.展开更多
AIM To investigate the impact of timing of same-admission orthotopic heart transplant(OHT) after left ventricular assist device(LVAD) implantation on in-hospital mortality and post-transplant length of stay.METHODS Us...AIM To investigate the impact of timing of same-admission orthotopic heart transplant(OHT) after left ventricular assist device(LVAD) implantation on in-hospital mortality and post-transplant length of stay.METHODS Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.RESULTS Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four(7.5%) patients also underwent OHT duringthe same admission, which occurred on average 32 d(IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation("early") experienced increased in-hospital mortality(26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d("late"). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT. CONCLUSION In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT(at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.展开更多
BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation(ECMO)for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.AIM To review th...BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation(ECMO)for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.AIM To review the available literature to determine if there was any evidence.METHODS A systematic literature search through PubMed and EMBASE was undertaken according to specific key words.RESULTS The search resulted in 29 publications relevant to the subject:1 brief communication,1 surgical technique report,1 invited commentary,1 retrospective case review,1 observational study,4 retrospective reviews,13 case reports and 7 conference abstracts.A total of 194 patients were included in these publications of whom 77 survived.CONCLUSION Although there is no compelling evidence for or against the use of ECMO in major aortic surgery or dissection,it is enough to justify its use in this patient population despite current adverse attitude.展开更多
Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation h...Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure.Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure.The question of when to implant these devices in those patients with advanced,yet still ambulatory heart failure remains a controversial topic.We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.展开更多
Takotsubo syndrome(TTS),also known as stressinduced cardiomyopathy,presents clinical manifestations similar to acute coronary syndrome(ACS).[1] Accurate and timely differentiation is crucial in emergency settings.Para...Takotsubo syndrome(TTS),also known as stressinduced cardiomyopathy,presents clinical manifestations similar to acute coronary syndrome(ACS).[1] Accurate and timely differentiation is crucial in emergency settings.Paraganglioma is a rare neuroendocrine tumor originating from extra-adrenal chromaffin tissue.It is characterized by excessive catecholamine secretion,which can lead to severe hemodynamic and metabolic disturbances.We herein report a case of TTS complicated by cardiac shock caused by paraganglioma.Following mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation(V-A ECMO) and appropriate preoperative management,the patient underwent successful tumor resection and achieved full recovery.展开更多
INTRODUCTION ＂End-stage heart disease＂ commonly refers to an irreversible stage of cardiac decompensation caused by a variety of pathologies that cannot be treated using conventional drugs or traditional surgical tr...INTRODUCTION ＂End-stage heart disease＂ commonly refers to an irreversible stage of cardiac decompensation caused by a variety of pathologies that cannot be treated using conventional drugs or traditional surgical treatments. The life expectancy of patients with end-stage heart disease ranges from 〈6 months to 1 year. Therapeutic strategies for end-stage heart disease patients are primarily based on three approaches： Internal medicine therapy, surgical therapy （heart transplantation）, and multiple organ protection therapy via the core method of mechanical circulation assistance. Among these approaches, heart transplantation has become recognized as the most efl＇ective treatment.展开更多
Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces mor...Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.展开更多
The prevalence of the risk factors and the risk of cardiac failure are both increasing in China.This might be the consequence of the changes of the life conditions(emigration to the urban areas,changes in the diet and...The prevalence of the risk factors and the risk of cardiac failure are both increasing in China.This might be the consequence of the changes of the life conditions(emigration to the urban areas,changes in the diet and life style,lack of physical exercise,etc.).The wide range of clinical presentations of cardiac failure(acute or chronic)and of therapeutic approaches(medical or surgical)makes necessary the integration within the same structure of the various experts involved in the diagnosis and the treatment of cardiac diseases.Technologic and human resources required to offer all the options represent a multifaceted commitment which should be focused optimally in dedicated centers.In these centers,collaboration should replace competition between the medical and the surgical cardiac specialists.Development of team work should permit to optimize the cost efficacy of the treatments.Most of all,such a structure will facilitate the translation of innovative therapies between the research centers and clinical facilities.展开更多
Extracorporeal membrane oxygenation has emerged as a viable alternative for stabilizing and improving critically ill patients in acute cardiovascular diseases.However,the weaning stage has been associated with a high ...Extracorporeal membrane oxygenation has emerged as a viable alternative for stabilizing and improving critically ill patients in acute cardiovascular diseases.However,the weaning stage has been associated with a high morbidity and mortality rate.This makes searching for strategies that reduce failure in this final process necessary.Implementing a new approach must be tried and included in our protocols,seeking the patient’s well-being at all times.In this article,the authors discuss their point of view regarding potential pharmacological alternatives and the mechanism of action involved,which could decrease the mortality associated with this therapeutic.展开更多
文摘Temporary mechanical circulatory support (tMCS) devices such as intra-aorticballoon pumps, veno-arterial extracorporeal membrane oxygenation, and percutaneousventricular assist devices, play a major role in supporting patients withend-stage heart failure and bridging them to transplant. In 2018, the United Networkfor Organ Sharing heart allocation criteria was modified by increasing thenumber of statuses in the heart transplant waitlist to differentiate and favor thesickest patients awaiting transplantation. Within this new system, patients withtMCS devices receive the highest priority statuses. While the 2018 allocationsystem has reduced waitlist times and mortality for the highest-priority patients,some studies have shown a concomitant rise in the utilization of tMCS devices asbridge to transplant after its enaction. In this narrative review, we describe thesechanges in tMCS utilization and provide insights on how the upcoming creationof a continuous distribution allocation system may further impact these trends.
文摘Objective To investigate the clinical outcomes of children with congenital heart disease （CHD） requiring extracorporeal membrane oxygenation （ECMO） and left ventricular assist device （LVAD） support after cardiac surgery. Methods A total of 22 patients with CHD who required postcardiotomy mechanical circulatory support between March 2004 and March 2011 （85 months ） were analyzed retrospectively. Median age of the patients was 420 d （ 15 d - 4 years） and median weight was 3.4 kg （ 2 - 14. 5 kg ）. Eight patients were put on ECMO, while 14 patients were placed on LVAD. Results Thirteen （59%） patients died and 9 （41% ） survived to discharge. In survivals, the duration of LVAD and the duration of ECMO were both shorter than those of nonsurvivals （P 〈 O. 05）. The main complication was bleeding. Conclusion The earlier treatment and application of more advanced cardiac support devices for CHD patients are key factors for reducing complications.
文摘Cardiogenic shock(CS)is a complex clinical syndrome with a high mortality rate.It can occur to due to multiple etiologies of cardiovascular disease and is phenotypically heterogeneous.Acute myocardial infarction-related CS(AMI-CS)has historically been the most prevalent cause,and thus,research and guidance have focused primarily on this.Recent data suggest that the burden of non-ischemic CS is increasing in the population of patents requiring intensive care admission.There is,however,a paucity of data and guidelines to inform the management of these patients who fall into two broad groups:those with existing heart failure and CS and those with no known history of heart failure who present with"de novo"CS.The use of temporary mechanical circulatory support(MCS)has expanded across all etiologies,despite its high cost,resource intensity,complication rates,and lack of high-quality outcome data.Herein,we discuss the currently available evidence on the role of MCS in the management of patients with de novo CS to include fulminant myocarditis,right ventricular(RV)failure,Takotsubo syndrome,post-partum cardiomyopathy,and CS due to valve lesions and other cardiomyopathies.
文摘Heart transplantation(HTx)is a life-saving procedure for patients with end-stage heart failure and has undergone remarkable advancements since the first succe-ssful transplant in 1967.The introduction of cyclosporine in the 1970s significantly improved patient outcomes,leading to a global increase in transplants,including in India,where the practice has grown despite initial challenges.This review pro-vides an extensive overview of HTx,focusing on current practices,technological advancements,and the ongoing challenges the field faces today.It explores the evolution of surgical techniques,such as minimally invasive and robotic-assisted procedures,and the management of posttransplant rejection through tailored immunosuppressive strategies,including new monoclonal antibodies and perso-nalized therapies.The review also highlights emerging innovations such as mechanical circulatory support devices and xenotransplantation as potential solutions to donor shortages while acknowledging the ethical and logistical challenges these approaches entail.Furthermore,the analysis delves into the implications of using extended-criteria donors and the role of multidisciplinary teams in evaluating absolute and relative contraindications.Despite the progress made,the persistent issues of organ scarcity and ethical concerns underscore the need for ongoing research and innovation to further enhance the efficacy,safety,and accessibility of HTx.
文摘BACKGROUND Acute and extreme insulin resistance with persistent hyperglycemia requiring excessively high doses of insulin before rapidly resolving is rare and has been referred to as transient and extreme insulin resistance(TEIR).The underlying pathophysiology and optimal management of TEIR are poorly understood,and previous reports of TEIR in the literature are sparse.This report is the first description of TEIR in a patient requiring mechanical circulatory support(MCS).CASE SUMMARY A 62-year-old male developed cardiogenic shock and was placed on veno-arterial extracorporeal membrane oxygenation following percutaneous coronary intervention and successful revascularization.Over the next 24 hours,glucose levels rose and remained markedly elevated despite increasing insulin infusion rates and repeated boluses.The insulin infusion rate peaked at 450 units/hour,and the patient received 4300 units(33 units/kg)of insulin over the 24-hour period of peak insulin resistance.Insulin resistance resolved rapidly,necessitating an abrupt decrease in the insulin infusion rate and development of rebound hypoglycemia.CONCLUSION Onset of TEIR did not seem to correlate with end-organ hypoperfusion or vasoactive drug dosing.
文摘Right ventricular(RV)failure accounts for significant morbidity and mortality in critically ill patients.The RV is particularly vulnerable in conditions characterized by elevated pulmonary vascular afterload,which are commonly encountered in the intensive care unit(ICU).Conditions such as acute respiratory distress syndrome,pulmonary embolism,and decompensated pulmonary arterial hypertension are associated with acute and acute-on-chronic RV failure.In the ICU,RV failure may develop or worsen in patients with parenchymal pulmonary disease who acutely experience fluctuations in preload,excessive afterload,and/or insufficient myocardial contractility,often in addition to mechanical ventilation and circulatory compromise.This dynamic clinical scenario demands early recognition and intervention tailored to an individual patient’s physiology.Distinguishing between acute and chronic RV failure in critical illness informs diagnostic workup,hemodynamic monitoring,and resuscitative efforts.This narrative review will provide an overview of common conditions associated with RV failure in critical illness,highlighting a practical,physiology-oriented approach to diagnosis and optimization of ventilator support,fluid resuscitation,vasopressor and inotrope use,and mechanical circulatory support.RV failure due to RV infarction or severe LV failure and decompensated congenital heart disease are distinct pathophysiologic entities.These conditions require distinct treatment approaches and are beyond the scope of this review.
文摘While biventricular assist devices(BiVADs)remain underutilized in Western countries for biventricular heart failure(BHF),their application is expanding in China.This consensus synthesizes international guidelines,medical evidence,and Chinese clinical expertise to establish standardized protocols for BiVAD management.Key recommendations include:(1)Preoperative right heart catheterization and echocardiography for central venous pressure(CVP):pulmonary capillary wedge pressure(PCWP)ratio and pulmonary artery pulsatility index(PAPi)assessment(Class I);(2)BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device(LVAD)implantation(Class IIa);(3)Right atrial implantation as the preferred surgical approach(Class IIa);(4)Warfarin-based anticoagulation(INR 2.0–2.5)with aspirin,avoiding direct oral anticoagulants(DOACs)(Class III).The guidance addresses critical gaps in patient selection,pump speed titration,and complication management,positioning integrated BiVAD systems as a promising solution for complex BHF.
文摘AIM To investigate the impact of timing of same-admission orthotopic heart transplant(OHT) after left ventricular assist device(LVAD) implantation on in-hospital mortality and post-transplant length of stay.METHODS Using data from the Nationwide Inpatient Sample from 1998 to 2011, we identified patients 18 years of age or older who underwent implantation of a LVAD and for whom the procedure date was available. We calculated in-hospital mortality for those patients who underwent OHT during the same admission as a function of time from LVAD to OHT, adjusting for age, sex, race, household income, and number of comorbid diagnoses. Finally, we analyzed the effect of time to OHT after LVAD implantation on the length of hospital stay post-transplant.RESULTS Two thousand and two hundred patients underwent implantation of a LVAD in this cohort. One hundred and sixty-four(7.5%) patients also underwent OHT duringthe same admission, which occurred on average 32 d(IQR 7.75-66 d) after LVAD implantation. Of patients who underwent OHT, patients who underwent transplantation within 7 d of LVAD implantation("early") experienced increased in-hospital mortality(26.8% vs 12.2%, P = 0.0483) compared to patients who underwent transplant after 8 d("late"). There was no statistically significant difference in age, sex, race, household income, or number of comorbid diagnoses between the early and late groups. Post-transplant length of stay after LVAD implantation was also not significantly different between patients who underwent early vs late OHT. CONCLUSION In this cohort of patients who received LVADs, the rate of in-hospital mortality after OHT was lower for patients who underwent late OHT(at least 8 d after LVAD implantation) compared to patients who underwent early OHT. Delayed timing of OHT after LVAD implantation did not correlate with longer hospital stays post-transplant.
文摘BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation(ECMO)for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.AIM To review the available literature to determine if there was any evidence.METHODS A systematic literature search through PubMed and EMBASE was undertaken according to specific key words.RESULTS The search resulted in 29 publications relevant to the subject:1 brief communication,1 surgical technique report,1 invited commentary,1 retrospective case review,1 observational study,4 retrospective reviews,13 case reports and 7 conference abstracts.A total of 194 patients were included in these publications of whom 77 survived.CONCLUSION Although there is no compelling evidence for or against the use of ECMO in major aortic surgery or dissection,it is enough to justify its use in this patient population despite current adverse attitude.
文摘Advanced heart failure has been traditionally treated via either heart transplantation,continuous inotropes,consideration for hospice and more recently via left ventricular assist devices(LVAD).Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure.Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure.The question of when to implant these devices in those patients with advanced,yet still ambulatory heart failure remains a controversial topic.We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.
文摘Takotsubo syndrome(TTS),also known as stressinduced cardiomyopathy,presents clinical manifestations similar to acute coronary syndrome(ACS).[1] Accurate and timely differentiation is crucial in emergency settings.Paraganglioma is a rare neuroendocrine tumor originating from extra-adrenal chromaffin tissue.It is characterized by excessive catecholamine secretion,which can lead to severe hemodynamic and metabolic disturbances.We herein report a case of TTS complicated by cardiac shock caused by paraganglioma.Following mechanical circulatory support with veno-arterial extracorporeal membrane oxygenation(V-A ECMO) and appropriate preoperative management,the patient underwent successful tumor resection and achieved full recovery.
基金Financial support and sponsorship This work was supported by a grant from National Natural Science Foundation of China （No. 81400290）.
文摘INTRODUCTION ＂End-stage heart disease＂ commonly refers to an irreversible stage of cardiac decompensation caused by a variety of pathologies that cannot be treated using conventional drugs or traditional surgical treatments. The life expectancy of patients with end-stage heart disease ranges from 〈6 months to 1 year. Therapeutic strategies for end-stage heart disease patients are primarily based on three approaches： Internal medicine therapy, surgical therapy （heart transplantation）, and multiple organ protection therapy via the core method of mechanical circulation assistance. Among these approaches, heart transplantation has become recognized as the most efl＇ective treatment.
基金This study was supported by“the Fundamental Research Funds for the Central Universities”(No.226-2022-00060)National Key R&D Program of China(No.2021YFC2701700).
文摘Background Congenital heart disease(CHD)is one of the main supportive diseases of extracorporeal membrane oxygena-tion in children.The management of extracorporeal membrane oxygenation(ECMO)for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart,special pathophysiology,perioperative complications and various concomitant malformations.The survival rate of ECMO for CHD was significantly lower than other classifica-tions of diseases according to the Extracorporeal Life Support Organization database.This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy.Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions.Results The primary concern of ECMO management in the perioperative period of CHD are patient selection,cannulation strategy,pump flow/ventilator parameters/vasoactive drug dosage setting,anticoagulation management,residual lesion screening,fluid and wound management and weaning or transition strategy.Prevention and treatment of complications of bleeding,thromboembolism and brain injury are emphatically discussed here.Special conditions of ECMO management related to the cardiovascular anatomy,haemodynamics and the surgical procedures of common complex CHD should be considered.Conclusions The consensus could provide a reference for patient selection,management and risk identification of periop-erative ECMO in children with CHD.
文摘The prevalence of the risk factors and the risk of cardiac failure are both increasing in China.This might be the consequence of the changes of the life conditions(emigration to the urban areas,changes in the diet and life style,lack of physical exercise,etc.).The wide range of clinical presentations of cardiac failure(acute or chronic)and of therapeutic approaches(medical or surgical)makes necessary the integration within the same structure of the various experts involved in the diagnosis and the treatment of cardiac diseases.Technologic and human resources required to offer all the options represent a multifaceted commitment which should be focused optimally in dedicated centers.In these centers,collaboration should replace competition between the medical and the surgical cardiac specialists.Development of team work should permit to optimize the cost efficacy of the treatments.Most of all,such a structure will facilitate the translation of innovative therapies between the research centers and clinical facilities.
文摘Extracorporeal membrane oxygenation has emerged as a viable alternative for stabilizing and improving critically ill patients in acute cardiovascular diseases.However,the weaning stage has been associated with a high morbidity and mortality rate.This makes searching for strategies that reduce failure in this final process necessary.Implementing a new approach must be tried and included in our protocols,seeking the patient’s well-being at all times.In this article,the authors discuss their point of view regarding potential pharmacological alternatives and the mechanism of action involved,which could decrease the mortality associated with this therapeutic.
