21 research outputs found
Impact of a surgical approach for implantation of durable left ventricular assist devices in patients on extracorporeal life support
Background The aim of this study was to evaluate the impact of the surgical approach on the postoperative outcome in patients who underwent left ventricular assist device (LVAD) implantation after having received veno-arterial extracorporeal life support (va-ECLS) using data from a European registry (ECLS-VAD). Five hundred and thirty-one patients were included. Methods A propensity score-adjusted outcome analysis was performed, resulting in 324 patients in the full sternotomy (FS) group and 39 in the less invasive surgery (LIS) group. Results The surgery lasted in median 236 min in the FS group versus 263 min in the LIS group (p = 0.289). The median chest tube output during the first 24 h was similar in both groups. Patients who underwent implantation with an FS required more blood products during the first 24 postoperative hours (median 16 vs. 12, p = 0.033). The incidence of revision due to bleeding was also higher (35.5 vs. 15.4%, p = 0.016). A temporary postoperative right ventricular assist device was necessary in 45.1 (FS) versus 23.1% (LIS) of patients, respectively (p = 0.067). No stroke occurred in the LIS group during the first 30 days after surgery (7.4% in the FS group). The incidence of stroke and of renal, hepatic, and respiratory failure during the follow-up was similar in both groups. The 30-day and one-year survival were similar in both groups. Conclusion LIS for implantation of a durable LVAD in patients on va-ECLS implanted for cardiogenic shock is associated with less revision due to bleeding, less administration of blood products and absence of perioperative stroke, with no impact on survival
Minimally Invasive Segmental Artery Occlusion Prior to Endovascular Repair of Thoraco-Abdominal Aortic Aneurysm to Reduce the Risk of Spinal Cord Injury
Rescue Surgery 19 Years after Composite Root and Hemiarch Replacement
A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique
SURVIVAL AFTER BIOLOGICAL AORTIC ROOT REPLACEMENT WITH A XENOBENTALL: A SINGLE CENTER EXPERIENCE OF 612 CONSECUTIVE PATIENTS
Is implantable cardioverter defibrillator surgery in patients with an implanted left ventricular assist device safe under uninterrupted oral anticoagulation?
Abstract
Background: Implantable cardioverter-defibrillator
(ICD) surgery in patients
with implanted left ventricular assist devices (LVAD) is associated with an increased
risk of bleeding complications because of the need to ensure that these
patients are adequately anticoagulated. Our study aimed to evaluate the safety
of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging
during the surgical interval.
Methods: Between January 2009 and January 2020, 116 patients with LVAD
underwent ICD surgery. Since January 2015, 60 patients were operated under
continued sufficient oral anticoagulation with a vitamin k antagonist (VKA
group). Fifty-six
patients underwent a heparin-bridging
regimen (heparin group).
Demographics, perioperative data, complications, and mortality were analyzed.
Results: Bleeding complications attributable to the surgical intervention occurred
more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re-exploratory
surgery
(14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical
significance. Moreover, the heparin group patients' postoperative total length of
stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were
no procedure-related
deaths, no thromboembolic events, and no LVAD-related
thrombosis.
Conclusion: Our strategy of uninterrupted oral anticoagulation is safe and results
in a reduction by more than half the number of days in hospital without an
increase in adverse events
Acute type A aortic dissection: characteristics and outcomes comparing patients with bicuspid versus tricuspid aortic valve
Is implantable cardioverter defibrillator surgery in patients with an implanted left ventricular assist device safe under uninterrupted oral anticoagulation?
Abstract
Background: Implantable cardioverter-defibrillator
(ICD) surgery in patients
with implanted left ventricular assist devices (LVAD) is associated with an increased
risk of bleeding complications because of the need to ensure that these
patients are adequately anticoagulated. Our study aimed to evaluate the safety
of our new strategy of uninterrupted oral anticoagulation compared to heparin-bridging
during the surgical interval.
Methods: Between January 2009 and January 2020, 116 patients with LVAD
underwent ICD surgery. Since January 2015, 60 patients were operated under
continued sufficient oral anticoagulation with a vitamin k antagonist (VKA
group). Fifty-six
patients underwent a heparin-bridging
regimen (heparin group).
Demographics, perioperative data, complications, and mortality were analyzed.
Results: Bleeding complications attributable to the surgical intervention occurred
more often (19.6% vs. 10.0%, p = 0.142) and at a higher rate of re-exploratory
surgery
(14.3% vs. 5.0%, p = 0.088) in the heparin group without reaching statistical
significance. Moreover, the heparin group patients' postoperative total length of
stay was 10 days longer (17.8 ± 23.8 days vs. 8.3 ± 9.5 days, p = 0.007). There were
no procedure-related
deaths, no thromboembolic events, and no LVAD-related
thrombosis.
Conclusion: Our strategy of uninterrupted oral anticoagulation is safe and results
in a reduction by more than half the number of days in hospital without an
increase in adverse events