Thyrotoxicosis-facilitated bridge to recovery with a continuous-flow left ventricular assist device

The HeartMate II is a continuous-flow left ventricular assist device that can be explanted from patients after cardiac recovery. We implanted a HeartMate II in a 21-year-old man who had idiopathic cardiomyopathy. A year later, he developed thyrotoxicosis, presumably secondary to amiodarone administered for ventricular fibrillation. Four months after the diagnosis of thyrotoxicosis, thyroid hormone levels had returned to normal, and native cardiac function had improved remarkably. After a support period of 24 months, the HeartMate II was explanted. Six years later, the patient continues to be in New York Heart Association functional Class I. Amiodarone-induced thyrotoxicosis may have contributed to myocardial recover

Orthotopic cardiac transplantation after minimally invasive direct coronary artery bypass

AbstractJ Thorac Cardiovasc Surg 1999;117:390-

Impact of distal aortic and visceral perfusion on liver function during thoracoabdominal and descending thoracic aortic repair

AbstractPurpose: We examined the impact of distal aortic and visceral perfusion on liver function during thoracoabdominal and descending thoracic aortic repair. Methods: Between January 1991 and July 1996, 367 patients underwent thoracoabdominal and descending thoracic aortic repair. Baseline and postoperative total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, lactate dehydrogenase, fibrinogen, prothrombin time (PT), and partial thromboplastin time (PTT) were measured for 286 patients. We examined the impact of distal aortic and direct visceral perfusion on liver function–related clinical laboratory values. Univariate and multivariate statistical methods for categorical and continuous variables were used. Results: In categorical analysis, type II thoracoabdominal aortic aneurysm, history of hepatitis, and emergency presentation had a statistically significant multivariate association with abnormal laboratory values. In continuous-distributed multivariate data analysis, type II thoracoabdominal aortic aneurysm and visceral perfusion were statistically significant predictors of postoperative alkaline phosphatase, PT, and PTT. Type II aneurysms increased postoperative liver function–related laboratory values significantly above other aneurysm types (alkaline phosphatase, +114 IU, p < 0.0001; PT, +1.99 seconds, p < 0.02; PTT, +6.7 seconds, p < 0.03). Visceral perfusion was associated with a concomitant decrease (alkaline phosphatase, –101.2 IU, p < 0.0001; PT, –1.8 seconds, p < 0.07; PTT, –5.6 seconds, p < 0.02). Conclusions: Visceral perfusion negates the rise in postoperative liver function–related clinical laboratory values associated with type II thoracoabdominal aortic aneurysm repair. (J Vasc Surg 1998;27:145-53.