Operative Techniques in Thoracic and Cardiovascular Surgery最新文献_第9页

Valved Conduit for Norwood-Sano Procedure 用于诺伍德-萨诺程序的阀式导管

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2023-10-01 DOI: 10.1053/j.optechstcvs.2023.09.005

David Kalfa MD, PhD, Edward Buratto MD, PhD, Andrew Goldstone MD, PhD, Emile Bacha MD

{"title":"Valved Conduit for Norwood-Sano Procedure","authors":"David Kalfa MD, PhD, Edward Buratto MD, PhD, Andrew Goldstone MD, PhD, Emile Bacha MD","doi":"10.1053/j.optechstcvs.2023.09.005","DOIUrl":"10.1053/j.optechstcvs.2023.09.005","url":null,"abstract":"<div>Use of a valved Sano (VS) during the Norwood procedure has been reported previously, but is not widely used and its impact on clinical outcomes needs to be further elucidated. Our institution shifted practice to the VS operation entirely in 2019, using a valved femoral venous homograft. We describe our technique in the present report. The VS technique is well codified and highly reproducible. Pre-Glenn echocardiograms showed competent conduit valves in two-thirds of the VS patients (n = 16/25, 66.7%). We retrospectively reviewed 25 consecutive HLHS neonates who underwent a Norwood procedure with a VS conduit using a femoral venous homograft and 25 consecutive HLHS neonates who underwent a Norwood procedure with a non-valved Sano (NVS) conduit between 2013 and 2022. Hospital survival for the VS group was 96%. Postoperatively, VS patients had significantly lower peak and postoperative day 1 lactate levels (p = 0.033 and p = 0.025 respectively), shorter time to diuresis (p = 0.043), and shorter time to enteral feeds (p = 0.038). The VS group had significantly fewer PA reinterventions until the Glenn (n = 1 vs 8; p = 0.044). The VS group showed significant improvement in ventricular function from the immediate postoperative period to discharge (p < 0.001). From preoperative to pre-Glenn time points, analysis of ventricular function showed sustained ventricular function within the VS group, but a significant reduction of ventricular function in the NVS group (p = 0.003). The use of a valved conduit for Norwood-Sano procedure is a reproducible technique, associated with improved multi-organ recovery, ventricular function recovery and fewer PA reinterventions.</div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"29 1","pages":"Pages 25-36"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135406755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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A Novel Approach for Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Left Ventricular Decompression Therapy With Impella (ECPella) 体外膜肺氧合与左心室减压疗法（ECPella）同时进行的新方法

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2024-01-01 DOI: 10.1053/j.optechstcvs.2023.11.004

Breah Paciotti MPH, PA-C , Pankaj Garg MBBS , James Postier , Amy Lykins APRN, DNP , Basar Sareyyupoglu MD

{"title":"A Novel Approach for Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Left Ventricular Decompression Therapy With Impella (ECPella)","authors":"Breah Paciotti MPH, PA-C , Pankaj Garg MBBS , James Postier , Amy Lykins APRN, DNP , Basar Sareyyupoglu MD","doi":"10.1053/j.optechstcvs.2023.11.004","DOIUrl":"10.1053/j.optechstcvs.2023.11.004","url":null,"abstract":"<div>Percutaneously placed veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is commonly used to support patients with refractory cardiac arrhythmias or arrest and worsening cardiogenic shock. Peripheral VA-ECMO by retrograde flow of blood in the aorta results in a significant increase in left ventricle (LV) afterload. A severely dysfunctional LV may be unable to overcome this afterload to open the aortic valve and unload itself. This may lead to LV distension, increased LV pressure, poor coronary blood circulation, increased left atrial pressures, pulmonary edema, and pulmonary hypertension. Moreover, it jeopardizes ventricular recovery, particularly in the presence of ischemia-induced myocardial impairment. Furthermore, if the aortic valve remains closed during the cardiac cycle, stasis of blood in the LV and aortic root may increase the risk of thrombus formation. These complications may preclude cardiac recovery and the patient from being a heart transplant candidate. In patients with cardiogenic shock, utilizing Impella with VA-ECMO, commonly referred to as ECPella, has consistently been shown to reduce mortality and improve outcomes. Patients who need prolonged ECPella support as a bridge to recovery or transplant may remain bed-bound since ambulation of patients with 2 mechanical circulatory support devices is challenging. We present the technique of ECPella placement through Y chimney graft anastomosis on the axillary artery for arterial cannula and Impella insertion and percutaneous cannulation of the right internal Jugular vein for venous cannula. This technique gives the ease of ambulation and decannulation of VA-ECMO under local anesthesia without requiring intubation or a trip to the operating room.</div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"29 1","pages":"Pages 2-24"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139126143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Introduction to Spring 2024 2024 年春季介绍

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2024-03-22 DOI: 10.1053/j.optechstcvs.2024.03.001

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Commentary: I'd love to agree with you, but then we would both be wrong 评论：我很想同意你的观点，但那样我们就都错了

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2024-02-12 DOI: 10.1053/j.optechstcvs.2023.12.004

Ronald K. Woods MD, PhD

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Commentary: The Expanding Norwood Tool Kit—You Decide 评论：不断扩大的诺伍德工具包--由您决定

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2023-10-28 DOI: 10.1053/j.optechstcvs.2023.09.006

Tracy R. Geoffrion MD, MPH, Ronald K. Woods MD, PhD

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Commentary: Right Upper Lobe Segmentectomies : A Game of Details 评论：右上叶段切除术：细节的游戏。

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2023-12-07 DOI: 10.1053/j.optechstcvs.2023.11.003

George Rakovich MD, MA(Ed)

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Aortic Arch Reconstruction in the Norwood Procedure: The “Reimplantation” Technique 诺伍德手术中的主动脉弓重建：再植 "技术

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2023-09-17 DOI: 10.1053/j.optechstcvs.2023.09.002

David J Barron FRCS(CT) , Abeeshan Selvabaskaran BSc , Shi-Joon Yoo PhD, MD , Kok Hooi Yap FRCS , William J Brawn FRCS

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Recent Articles in AATS Journals 最近在 AATS 期刊上发表的文章

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2024-03-05 DOI: 10.1053/j.optechstcvs.2024.02.001

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Commentary: The Value Of Great Tools And Strategy 评论：伟大工具和战略的价值

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2024-02-10 DOI: 10.1053/j.optechstcvs.2023.12.003

Igor E. Konstantinov MD, PhD, FRACS

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How He Did It – The James S. Tweddell Approach to Single Ventricle Palliation in Patients With Hypoplastic Left Heart Syndrome 他是如何做到的--詹姆斯-S-特威德尔为左心发育不全综合征患者实施单心室减容术的方法

Operative Techniques in Thoracic and Cardiovascular Surgery Pub Date : 2024-03-01 Epub Date: 2023-12-05 DOI: 10.1053/j.optechstcvs.2023.10.003

Alan P. O'Donnell PA-C, David G. Lehenbauer MD

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