Proximal repair in acute type A aortic dissection: The dark side of the root

Abstract There is no agreement regarding the best treatment for proximal repair in acute type A aortic dissection. Isolated replacement of the ascending aorta has been shown effective but can leave patients at a higher risk of further aortic procedures. The interpretation of the results coming from the literature is difficult because of the great variability of the clinical scenarios and the anatomic extension of the dissection. The analysis of the risk factors suggests that the presence of the underlying root pathology and a more extensive involvement of the aortic root should address the surgeon towards a more radical proximal resection

A Protocol for Space Charge Measurements in Full-size HVDC Extruded Cables

This position paper, prepared by the IEEE DEIS HVDC Cable Systems Technical Committee, illustrates a protocol recommended for the measurement of space charges in full-size HVDC extruded cables during load cycle qualification tests (either prequalification load cycles or type test load cycles). The protocol accounts for the experimental practices of space charge measurements in the thick insulation of coaxial cables in terms of poling time, depolarization time, heating and cooling of specimens, as well as for the experience gained very recently from such kind of measurements performed in the framework of qualification tests relevant to ongoing HVDC cable system projects. The goal of the protocol is not checking the compliance with any maximum acceptable limit of either space charge or electric field. Rather, this protocol aims at assessing the variation of the electric field profile in the cable insulation wall during poling time at the beginning and at the end of load cycle qualification tests for full-size HVDC extruded cables. Indeed, in the design stage the electric field distributions are determined by the cable geometry and by temperature gradient in the insulation. Thus, the design is based on macroscopic parameters conductivity and permittivity and how they depend upon temperature. Any disturbance of the electric field due to space charge accumulation will only be revealed during space charge measurements either in as-manufactured state or in the aged state after load cycle qualification tests

EWICON II: de ontwikkeling van een Elektrostatische Windenergie Converter II: Openbare eindrapportage

Doel van dit project was om een converter te ontwikkelen die windenergie met behulp van elektrostatische principes direct kan omzetten in elektrische energie. Het idee hierbij is om elektrisch geladen deeltjes te laten meevoeren in de wind en vervolgens elektrostatisch af te remmen, waardoor elektrostatische energie kan worden gegenereerd

The Insulation of HVDC Extruded Cable System Joints. Part 1: Review of Materials, Design and Testing Procedures

This position paper by the DEIS HVDC Cable Systems Technical Committee provides a review of existing diagnostic electrical and dielectric techniques for testing the insulation of polymeric extruded HVDC cable joints in the present Part 1. Here, the state of the art on the insulation of HVDC extruded cable system joints is covered with reference to types, design and testing techniques. This helps to identify routine tests as the first target for the onset of new testing procedures, AC-PD measurements as the readily-available measurement from manufacturers' practices for quality control of the insulation of accessories during routine tests and VHF/UHF wireless sensors as the best tool for performing such measurements on joints in the noisy factory environment. Thereby, a novel protocol for the measurement of partial discharges using AC voltages and VHF/UHF sensors, for quality control during routine tests on such joints, is derived in the next Part 2. This protocol is the main novelty of this investigation

The Insulation of HVDC Extruded Cable System Joints. Part 2: Proposal of a New AC Voltage PD Measurement Protocol for Quality Control during Routine Tests

The review of materials, design and testing of joints for HVDC extruded cable systems provided in previous Part 1 paved the way to this Part 2 position paper by the DEIS HVDC Cable Systems Technical Committee, whose aim is to remedy the scarcity of existing standardized tests on joints. After a sound analysis, here routine tests are identified as the first practical target for the onset of new testing procedures, AC-PD measurements as the readily-available measurement from manufacturers’ experience for quality control of joints during routine tests and VHF/UHF wireless sensors as the best tool for such measurements in the noisy environment of factories. Thereby, a novel protocol for PD measurement using AC voltages and VHF/UHF electromagnetic sensors, for quality control during routine tests on HVDC extruded joints, is proposed

Haemodynamic efficacy of microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis

The Impella percutaneous mechanical circulatory support device is designed to augment cardiac output and reduce left ventricular wall stress and aims to improve survival in cases of cardiogenic shock. In this meta-analysis we investigated the haemodynamic effects of the Impella device in a clinical setting. We systematically searched all articles in PubMed/Medline and Embase up to July 2019. The primary outcom

Impact of extra-corporeal life support (ECLS) cannulation strategy on outcome after durable mechanical circulation support system implantation on behalf of durable MCS after ECLS Study Group

Background: The literature on outcomes of patients requiring durable mechanical circulatory support (MCS) after extra-corporeal life support (ECLS) is limited. The aim of this study was to investigate the impact of preoperative ECLS cannulation on postoperative outcome after durable MCS implantation. Methods: The durable MCS after ECLS registry is a multicenter retrospective study that gathered data on consecutive patients who underwent durable MCS implantation after ECLS between January 2010 and August 2018 in eleven high volume European centers. Patients who underwent the implantation of total artificial heart, pulsatile pumps, or first-generation pumps after ECLS were excluded from the analysis. The remaining patients were divided into two groups; central ECLS group (cECLS) and peripheral ECLS group (pECLS). A 1:1 propensity score analysis was performed to identify two matched groups. The outcome of these two groups was compared. Results: A total of 531 durable MCS after ECLS were implanted during this period. The ECLS cannulation site was peripheral in 87% (n=462) and central in 13% (n=69) of the patients. After excluding pulsatile pumps and total artificial heart patients, a total of 494 patients remained (pECLS =434 patients, cECLS =60 patients). A 1:1 propensity score analysis resulted in 2 matched groups (each 55 patients) with median age of 54 years (48-60 years) in cECLS group and 54 years (43-60 years) in pECLS group. HeartWare HVAD (Medtronic, Minneapolis, MN) was implanted in the majority of the patients (cECLS =71% vs. pECLS =76%, P=0.67). All postoperative morbidities were comparable between the groups. The thirty-day, one year and long-term survival was comparable between the groups (P=0.73). Conclusions: The cannulation strategy of ECLS appears to have no impact on the post-operative outcome after durable MCS implantation

Case-control study on the interplay between immunoparalysis and delirium after cardiac surgery

BACKGROUND: Delirium occurs frequently following cardiothoracic surgery, and infectious disease is an important risk factor for delirium. Surgery and cardiopulmonary bypass induce suppression of the immune response known as immunoparalysis. We aimed to investigate whether delirious patients had more pronounced immunoparalysis following cardiothoracic surgery than patients without delirium, to explain this delirium-infection association. METHODS: A prospective matched case-control study was performed in two university hospitals. Cytokine production (tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8 and IL-10) of ex vivo lipopolysaccharide (LPS)-stimulated whole blood was analyzed in on-pump cardiothoracic surgery patients preoperatively, and at 5 timepoints up to 3 days after cardiothoracic surgery. Delirium was assessed by trained staff using two validated delirium scales and chart review. RESULTS: A total of 89 patients were screened of whom 14 delirious and 52 non-delirious patients were included. Ex vivo-stimulated production of TNF-α, IL-6, IL-8, and IL-10 was severely suppressed following cardiothoracic surgery compared to pre-surgery. Postoperative release of cytokines in non-delirious patients was attenuated by 84% [IQR: 13-93] for TNF-α, 95% [IQR: 78-98] for IL-6, and 69% [IQR: 55-81] for IL-10. The attenuation in ex vivo-stimulated production of these cytokines was not significantly different in patients with delirium compared to non-delirious patients (p > 0.10 for all cytokines). CONCLUSIONS: The post-operative attenuation of ex vivo-stimulated production of pro- and anti-inflammatory cytokines was comparable between patients that developed delirium and those who remained delirium-free after on-pump cardiothoracic surgery. This finding suggests that immunoparalysis is not more common in cardiothoracic surgery patients with delirium compared to those without