Impact of preoperative left ventricular ejection fraction on long-term survival after aortic valve replacement for aortic stenosis.

Background: The survival of patients who undergo aortic valve replacement (AVR) for severe aortic stenosis with reduced preoperative ejection fractions (EFs) is not well described in the literature.

Methods And Results: Patients undergoing AVR for severe aortic stenosis were analyzed using the Northern New England Cardiovascular Disease Study Group surgical registry. Patients were stratified by preoperative EF (≥50%, 40%-49%, and <40%) and concomitant coronary artery bypass grafting.

Effect of prior cardiac operations on survival after coronary artery bypass grafting.

Background: We examined a recent regional experience to determine the effect of a prior cardiac operation on short-term and midterm outcomes after coronary artery bypass grafting (CABG).

Methods: We identified 20,703 patients who underwent nonemergent CABG at 8 centers in northern New England from 2000 to 2008, of whom 818 (3.8%) had undergone prior cardiac operations.

Detection and elimination of microemboli related to cardiopulmonary bypass.

Background: Neurobehavioral impairment is a common complication of coronary bypass surgery. Cerebral microemboli during cardiopulmonary bypass (CPB) are a principal mechanism of cognitive injury. The aim of this work was to study the occurrence of cerebral embolism during CPB and to evaluate the effectiveness of evidence-based CPB circuit component and process changes on the exposure of the patient to emboli.

Heparin-induced thrombocytopenia with thrombosis syndrome managed with plasmapheresis.

Heparin-induced thrombocytopenia with thrombosis syndrome is an antibody-mediated disorder that has a high mortality in cardiac surgical patients in spite of early diagnosis and management with direct thrombin inhibitors. Plasmapheresis, an extracorporeal technique that has been designed for the removal of large molecular weight substances from the plasma, can remove the offending antibodies from these desperately ill patients. We describe a case of a postoperative cardiac surgery patient with heparin-induced thrombocytopenia with thrombosis syndrome and multi-system failure who was dependent upon a left ventricular assist device.

Successful management of a left ventricular assist device malfunction in an outpatient setting.

Heart disease kills as many people as nearly all other causes of death combined. Chronic, progressive, end-stage heart failure results in substantial health care costs and immeasurable suffering for both individuals in particular and society in general. Ventricular assist devices are having an increasing role in supporting patients with severe circulatory compromise.