Total Artificial Heart Implantation Blood Pressure Management as Resolving Treatment for Massive Hemolysis following Total Artificial Heart Implantation

The SynCardia Total Artificial Heart (TAH) has been used for patients with biventricular failure, who cannot be managed with implantation of a left ventricular (LV) assist device. Following TAH implantation, our patient developed severe hemolysis, which could only be managed successfully by aggressive blood pressure control [Ohashi 2003; Nakata 1998]

Prevention of cardiac herniation and left artery descending obstruction in cases of extensive surgical pericardial window procedure

The thoracotomy approach for pericardial window surgery was shown to be more effective at preventing effusion recurrence and the need for repeat surgery. However, cardiac herniation remains a common complication after extensive pericardial excision. This technical note describes a simple and effective technique to prevent potential heart herniation through the pericardial window and at the same time to avoid potential obstruction of the left artery descending

Rapid Diagnostics and Treatment of Early Complications after CABG Surgery: A Life Saver

Early graft failure after CABG surgery may lead to severe adverse events and death. Because the cause of the graft failure can vary, rapid diagnostic management is mandatory in order to address these complications appropriately. In the present 2 cases, patients who underwent CABG procedures showed typical electrocardiograms and serology of a peri-operative myocardial ischemia shortly after surgery. In the first case, a rapidly performed coronary angiogram revealed a torqued right CABG, which was detorqued and, in order to avoid further torsion, fixated to the pericardium in a redo procedure. In the second case, the patient underwent a revascularization by means of percutaneous coronary intervention with stent implantation for severe stenosis due to a localized dissection of the vein graft, diagnosed on coronary angiogram. The further postoperative course of both patients was smooth and both could be discharged on day 8 and 11 after initial surgery, respectively

Delayed chest closure with skin approximation after lung transplant in oversized graft

Closure of the chest after lung transplant in cases of oversized grafts is often difficult. Lung volume reduction and delayed closure of the chest with Bogota bag are the only options available in such situations. Here, we propose to keep the sternum and intercostal spaces open and approximate skin over it. Once lung function improves and reperfusion-related edema recovers, the chest can be closed

Single-center experience with the frozen elephant trunk procedure in 111 patients with complex aortic disease

Background: The frozen elephant trunk (FET) technique is increasingly used for the treatment of acute and chronic aortic arch disease. This study reports our single center experience with the FET technique in patients with complex aortic disease. Methods: Between 2009 and 2019, 111 consecutive patients underwent aortic arch surgery in our institution using the FET technique for acute type A dissection (AAD group; n=75) or non-acute type A dissection (non-AAD group; n=36; 10 patients with chronic type A dissection; 26 patients with aneurysm), respectively. Relevant perioperative data, including 30-day mortality and neurological complications, were retrospectively obtained from our electronic patients records, including follow-up (FU) data of outpatient clinical visits and computed tomography (CT). Results: Thirty-day mortality in the entire FET cohort was 16.2% (AAD 18.7% vs. non-AAD 11.1%; n=0.414). Severe brain injury was the leading cause of death in AAD patients (12.0% vs. 0% non-AAD; P=0.030). Overall permanent stroke and spinal cord injury was 12.6% and 3.6%. Four patients in the AAD group developed paraplegia and permanent stroke rate was significantly higher in AAD compared to non-AAD patients (17.3% vs. 2.8%; P=0.034). One, 3- and 5-year survival rates were 78.7%+/- 4.0%, 72.2%+/- 4.8%, and 64.3%+/- 6.8% for the total cohort; survival at 1-, 3- and 5-year was 76.7%+/- 5.0%, 71.0%+/- 6.1%, and 64.5%+/- 8.3% for the AAD cohort compared to 83.1%+/- 6.3%, 75.0%+/- 7.9% and 66.7% for non-AAD patients (P=0.579), respectively. Conclusions: Our single-center experience confirms good early and mid-term survival after the FET procedure in patients presenting with AAD, CAD and aneurysm. Future efforts should focus on reduction of severe neurological complication