Our results suggest that HCA/SCP is superior to HCA alone for preventing cerebral injury during operations on the aortic arch. By reducing embolic risk, as well as the duration of HCA, SCP with axillary artery direct cannulation may be the optimal technique for averting cerebral events, reducing complications, and shortening hospital stays following aortic arch repair.
The necessity for a secondary right heart assist device (RVAD) is a disastrous complication in left ventricular assist device (LVAD) support with respect to both complications and outcome. We have developed a new technique for inflow and outflow cannulation via a transcutaneous cannula in the femoral vein and a prosthesis-supported arterial cannula into the pulmonary artery, which does not necessitate rethoracotomy for device explantation. In addition to the simplified RVAD removal this transcutaneous approach may reduce the complications in patients requiring RVAD support.
We report a case of a patient suffering from massive myocardial infarction after traumatic dissection of the left coronary system. The dissection involved the left coronary artery including peripheral segments of the coronary circulation. The patient was revascularized; however, she could not be weaned from cardiopulmonary bypass thereafter. An Impella microaxial hemopump was implanted and the patient's left ventricular function markedly improved during the following days. Eight days later hemodynamics had stabilized far enough to explant the device, after explantation the patient remained hemodynamically stable and free of inotropic support. The report intends to emphasize the potential of the myocardium to recover even after extensive infarction under temporary ventricular support and takes the Impella microaxial hemopump into consideration as a device that is technically easy to implant with no injury to the ventricle and thus associated with good properties for weaning. Surgeons should consider the device as short-term support in borderline indications.
Aortic surgery still carries a high risk of brain damage that dominates postoperative morbidity and mortality. The concept and advantages of antegrade selective cerebral perfusion, which allows for numerous variations in its implementation, have been clearly seen for more than a decade now, but the preferred way of positioning remains unanswered. Ideal perfusion during ascending aorta/arch surgery should allow the easy implementation of selective antegrade cerebral perfusion while avoiding atheroembolization or false lumen perfusion during dissections.
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