[Mechanical circulatory support and replacement in heart failure].

MECHANICAL CIRCULATORY SUPPORT AND REPLACEMENT IN HEART FAILURE. Technological developments have led to a panel of mechanical devices making possible circulatory support and cardiac replacement in patients with heart failure. Some devices (namely extracorporeal membrane oxygenation or ECMO) allow short-term support in patients with acute heart failure and improve the prognosis.

Development of ventricular assist devices in China: present status, opportunities and challenges.

The growing number of heart failure patients and the scarcity of organ donors account for the huge need for the development of mechanical circulatory systems, including ventricular assist devices (VADs) and artificial hearts, in China. Several research programmes on blood pumps have been under way for the last three decades. However, unlike in other countries, the development of VADs has been extremely slow, and no system is currently approved and available for clinical application.

[Evaluation of new implantable medical devices].

Complex administrative procedures have gradually been established for the evaluation of implantable medical devices, resulting in improved patient safety. These procedures include in vitro testing, animal experimentation, clinical premarketing studies, and post-market surveillance. Further improvements are needed, however, including more independent experts and clinical studies, while ensuring that the approval process is neither to slow nor too hasty.

Colder is better during hypothermic circulatory arrest for acute type A aortic dissection.

Objectives: To evaluate the influence, on early postoperative outcomes, of temperature during hypothermic circulatory arrest in emergent surgery for acute type A aortic dissection.

Design: Hypothermic circulatory arrest (HCA) with antegrade cerebral perfusion was performed in 63 patients who underwent emergent surgery for acute type A aortic dissection between 2000 and 2009. Patients were retrospectively separated in two groups: ( 1 ) deep HCA, lowest nasopharyngeal temperature < 17 °C (n = 29; 46%) and ( 2 ) moderate HCA, lowest nasopharyngeal temperature ≥ 17 °C (n = 34; 54%).

Risk factors for hospital death after surgery for type A aortic dissection.

This study was undertaken to identify perioperative risk factors for hospital death in patients undergoing surgery for acute type A aortic dissection. Between 2000 and 2009, 101 consecutive patients underwent emergency surgery for acute type A aortic dissection. Four patients died before institution of cardiopulmonary bypass or completion of the procedure.

Importance of monocyte deactivation in determining early outcome after ventricular assist device implantation.

Background: Patients undergoing mechanical circulatory support using ventricular assist devices (VADs) experience a postoperative mixed antagonistic (proinflammatory and antiinflammatory) response syndrome. This response can result in immunoparalysis, exposing VAD recipients to infection and interfering with patient recovery despite adequate hemodynamic support. We undertook the present study to evaluate whether postoperative monocytic human leukocyte antigen-DR (mHLA-DR) expression is of prognostic value for mortality or infection of VAD recipients during their initial intensive care unit (ICU) stay after implantation.

[Basic surgical training in 2010].

Initial surgical training must take into account the major changes that have taken place in recent years. Training in surgical technique, clinical expertise, communication skills, clinical and experimental surgical research, team work and risk management is required to maintain the leadership position of future surgeons.

Integrated management of cardiac failure: the cardiac failure clinic.

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.).

[Cardiac surgery in China in 2010].

In China, cardiac surgery has been developing fast over the past 30 years, but it still cannot meet the huge demand created by the high prevalence of risk factors for cardiovascular disease, such as hypertension, diabetes and smoking, and the high frequency of congenital cardiopathies. In China, cardiac surgery is available in about 600 centers, but fewer than 10 centers account for the bulk of operations. Most of these high-volume centers are located in well-developed eastern cities, but cardiac surgery is growing at an extremely rapid pace in the western provinces too.

Temporary right ventricular support with Impella Recover RD axial flow pump.

Post-cardiotomy right ventricular failure is a serious complication that frequently results in adverse outcomes. We reviewed our experience with the Impella Recover RD (Impella Cardiosystems GMbH, Aachen, Germany). From January 2007 to December 2007, 7 patients (5 males, 54 +7 years old) had this device implanted for temporary support after heart transplantation in 4, after repeat mitral valve replacement in 2, and with a left ventricular assist device in 1.

Single-centre experience with the Thoratec paracorporeal ventricular assist device for patients with primary cardiac failure.

Background: Temporary mechanical circulatory support may be indicated in some patients with cardiac failure refractory to conventional therapy, as a bridge to myocardial recovery or transplantation.

Aims: To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal ventricular assist device (p-VAD).

Methods: We did a retrospective analysis of demographics, clinical characteristics and survival of patients assisted with a Thoratec p-VAD.

Composite freestyle stentless xenograft with Dacron graft extension for ascending aortic replacement.

Background: The present study was undertaken to evaluate clinical, hemodynamic, and morphologic results of composite stentless xenograft with polyethylene terephthalate fiber (Dacron; DuPont, Wilmington, DE) graft extension for combined replacement of the aortic valve, root, and ascending aorta.

Methods: Between 1997 and 2008, 55 consecutive patients (33 men, 71 +/- 11 years) underwent ascending aortic replacement using Medtronic Freestyle with Dacron graft extension (DuPont). Indications included aneurysm (n = 31, 56%), dissection (n = 16, 29%), and endocarditis (n = 8, 15%).

Long-term results of combined heart and kidney transplantation: a French multicenter study.

Background: Outcomes in recipients who have undergone combined heart and kidney transplantation have mainly been addressed in small, single-center studies. We studied long-term results of combined heart and kidney transplantation in a large multicenter cohort.

Methods: Between 1984 and 2007, 67 consecutive patients (61 men and 6 women) from 3 French centers underwent combined heart and kidney transplantation.

Off-pump replacement of the INCOR implantable axial-flow pump.

Owing to the actual increase of mechanical circulatory support durations, total or partial replacement of ventricular assist devices (VADs) will most certainly have to be performed with increasing frequency. Herein we report the case of a patient in whom an INCOR (Berlin Heart AG, Berlin) implantable axial-flow pump was replaced without the use of cardiopulmonary bypass (CPB), underscoring some of the unique features provided by this system.

[Pathobiology of idiopathic ascending aortic aneurysms].

Background: The majority of ascending aortic aneurysms cannot be related to any specific etiology and should be qualified as idiopathic. The incidence of this disease is increasing in the population of the developed countries but its pathobiology is poorly understood.

Aim: This article is reviewing the publications concerning the pathobiology of idiopathic ascending aortic aneurysms.

Multidisciplinary therapy of a large esophago-pericardial fistula arising from Barrett's esophagus.

Esophago-pericardial fistula is a rare complication of benign esophageal pathologies. We present the case report of a patient with Barrett's esophagus complicated by an esophago-pericardial fistula managed by a multi-therapeutic approach to close the fistula using an autologous pericardial patch; placement of a coated, expandable, metallic esophageal stent; and a feeding jejunostomy.