Ann Thorac Surg
November 1992
Sixteen patients (2 women, 14 men) aged 29 to 72 years with continued cardiogenic shock during intraaortic balloon pumping (IABP) had additional treatment with percutaneous cardiopulmonary bypass (PBY). Cause of cardiogenic shock was myocardial infarction in 7 (3 survived), failed percutaneous transluminal coronary angioplasty requiring emergency coronary artery bypass grafting in 5, postoperative aortic valve replacement in 1, postoperative emergency coronary artery bypass grafting in 1, after cardiac transplantation in 1, and bridging to transplantation in 1. Mean blood pressure with PBY and IABP combined was 75 mm Hg versus 60 mm Hg with IABP off.
View Article and Find Full Text PDFA technique is described that allows insertion of a standard percutaneous intraaortic balloon without use of the larger 12F sheath. Standard 9.5-cm.
View Article and Find Full Text PDFUnder fluoroscopy, the hemopump is passed through the aortic valve into the left ventricle through a Gortex (WF Gore, Denver, CO) chimney sewn to a surgically exposed femoral artery. The system aspirates the left ventricular blood and actively pumps it into the aorta. Five patients (four men, one woman), aged 47-71 years (mean, 62 years), were candidates for hemopump support because of refractory cardiogenic shock.
View Article and Find Full Text PDFSix infants with total anomalous pulmonary venous connection below the diaphragm had correction by modification of conventional surgical technique. Catheterization revealed the confluence of the pulmonary veins draining into a descending vein below the diaphragm. Symptoms of pulmonary venous hypertension and low cardiac output were typical.
View Article and Find Full Text PDFPulmonary artery banding is facilitated by simultaneously measuring the pressure above and below the band. This can be accomplished with a commercially available double-lumen central venous pressure monitoring catheter. This catheter is inserted through the outflow tract of the right ventricle and positioned so that the band will be between the two lumens.
View Article and Find Full Text PDFOf 2,859 patients having percutaneous transluminal coronary angioplasty, 201 (7%) underwent emergency coronary artery bypass grafting. Two categories of patients were reviewed. Group 1 consisted of 126 patients of 2,304 who had immediate coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty.
View Article and Find Full Text PDFThere is a large population of patients in end-stage congestive heart failure who cannot be treated by means of conventional cardiac surgery, cardiac transplantation, or chronic catecholamine infusions. In 2 such patients, we provided permanent left ventricular assistance on an outpatient basis by surgically implanting a modified intra-aortic balloon pump. A Dacron-velour graft to the common iliac artery served as a covering for the extravascular portion of the balloon's pneumatic tubing, which was stabilized by routing it through the iliac crest.
View Article and Find Full Text PDFAnn Thorac Surg
January 1989
Percutaneous cardiopulmonary bypass (CPB) was used in 22 patients: 7 patients with cardiac arrest due to acute myocardial infarction; 4 patients in cardiac arrest because of failed angioplasty; 1 patient for high-risk elective angioplasty; 1 patient with massive pulmonary emboli; 2 patients with hypothermia; 2 pediatric patients (1 with sepsis and 1 in combination with extracorporeal membrane oxygenator support); 1 patient with refractory arrhythmia; and 4 patients with trauma. Percutaneous CPB involves a modified Seldinger technique that is easily applied. All patients except those with massive trauma were resuscitated with the use of percutaneous CPB.
View Article and Find Full Text PDFIn 1975, 80 patients undergoing revascularization were prospectively randomized to receive either a greater saphenous vein (SV) graft (41 patients, Group 1) or a left internal mammary artery (LIMA) graft (39 patients, Group 2) to the left anterior descending coronary artery (LAD). All patients were completely revascularized. The average number of grafts per patient in both groups was 3.
View Article and Find Full Text PDFJ Heart Transplant
October 1987
Heart transplantation is becoming a useful tool in the clinical treatment of patients with end-stage cardiac decompensation. Donor organs are not always available at a critical time for a patient waiting for a transplant. Bridging techniques have been described that use mechanical support systems.
View Article and Find Full Text PDFAnn Thorac Surg
February 1986
Reperfusion is an accepted therapy for evolving myocardial infarction (MI), as successful reperfusion reduces morbidity and mortality. A team approach between the cardiologists and cardiac surgeons must be applied to achieve reperfusion within a finite time from the onset of coronary thrombosis. Analysis of 738 patients grouped them by successful reperfusion in the catheterization laboratory versus the operating room.
View Article and Find Full Text PDFJ Thorac Cardiovasc Surg
November 1984
Processed bovine pericardium is increasingly used as a pericardial substitute. It is allegedly nonreactive with epicardium, but adequate clinical data are lacking on this subject. A case report is presented wherein a dense epicardial reaction to processed bovine pericardium was found at reoperation.
View Article and Find Full Text PDFAnn Thorac Surg
September 1984
Intraaortic balloon pump counterpulsation is well established as a lifesaving measure. Aortic counterpulsation may be achieved externally as well as internally. A simple technique for manual external aortic counterpulsation during cardiovascular surgical procedures is presented.
View Article and Find Full Text PDFForty-one patients underwent resection of a postinfarction ventricular aneurysm. Thirty-seven of them had associated saphenous vein grafting procedures (average, 2.3 grafts per patient).
View Article and Find Full Text PDFJ Thorac Cardiovasc Surg
April 1984
Since December of 1980, 184 patients with evolving myocardial infarction (EMI) have undergone streptokinase infusion, with associated percutaneous transluminal coronary angioplasty (PTCA) in 68 patients. Emergency coronary bypass was deemed necessary in 24 of these patients. All 24 patients had severe triple-vessel disease and moderate to marked ventricular dysfunction, with eight (33%) requiring intra-aortic balloon pump (IABP) support for profound cardiac decompensation preoperatively.
View Article and Find Full Text PDFJ Thorac Cardiovasc Surg
November 1983
Between 1975 and 1982, 339 patients underwent emergency coronary artery reperfusion for treatment of evolving myocardial infarction (MI). Group I (112 patients) had reperfusion with intracoronary streptokinase. Group II (46 patients) had reperfusion with a combination of intracoronary streptokinase and percutaneous transluminal coronary angioplasty (PTCA).
View Article and Find Full Text PDFImproved technology has allowed us to develop support pumps that can be applied rapidly and safely. A system utilizing thin-walled (4 mm inner diameter) percutaneously inserted sheaths has been designed for rapid bedside arterial and central venous cannulation to establish femoral arterial and venous cardiopulmonary bypass. The system utilizes two 30-cm-long large-bore, thin-walled (end and side holes) venous cannulas and a single 15-cm-long (end hole) arterial reperfusion cannula, which is connected to a pediatric oxygenator and a vortex pump head.
View Article and Find Full Text PDFA patient with acute right ventricular failure and severe hemodynamic instability following coronary artery revascularization was treated with intra-aortic and intravenous balloon pumping. The intravenous balloon was timed to inflate during diastole and deflate during systole as did the intra-aortic balloon; in fact, the two were connected to the same system through a Y-connector. The intravenous balloon acted as an artificial atrium, which allowed approximately 20% improvement in the cardiac output when this intravenous balloon was functioning.
View Article and Find Full Text PDFOne hundred fifty-six patients underwent emergency coronary revascularization during the early phases of evolving myocardial infarction (MI). There were six hospital deaths (3.8%) and two later deaths (1.
View Article and Find Full Text PDFCoronary artery spasm is a well-documented phenomenon in patients undergoing medial treatment. We describe coronary artery spasm occurring in the immediate postoperative period following coronary artery bypass operation. The spasm occurred in a vessel that was not operated on and that had no apparent lesion.
View Article and Find Full Text PDFOne hundred thirty-eight selected patients underwent emergency coronary artery revascularization as the treatment for early evolving myocardial infarction. Low early and late (3.6 and 2.
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