| 1. |
|
|
| 2. |
- Wulff, John, et al.
(författare)
-
Flow characteristics of the Hemopump : an experimental in vitro study.
- 1997
-
Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 63:1, s. 162-166
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Hemopump (DLP/Medtronic) has been in clinical use for about 7 years. There is still no adequate way of determining actual output from the three available pump systems in the clinical situation. If the pump is completely stopped during weaning from the device, there is a possibility of back-leakage through the pump, endangering the patient from regurgitation into the left ventricle. It can also make it more difficult to judge the recovery of heart function because of a volume load of the left ventricle. The aim of this study was to evaluate in a standardized, experimental in vitro model the output from three different-sized Hemopump catheters at various pressure levels and to quantify the back-flow through the pumps.METHODS: The Hemopump models were tested in an in vitro study regarding total outflow at various speeds at three pressure levels. The back-flow through the pumps was also measured with the pumps at a complete stop.RESULTS: The outflow from the Hemopumps ranged from 0.4 to 4.5 L/min, depending on which pump and speed were used. Variations in total output, depending on speed and various pressure settings, could be up to 0.4 L/min. Back-flow through the pump into the left ventricle may be as great as 1.6 L/min.CONCLUSIONS: The flow outputs from the different Hemopump models were reproducible over time and were closely related to the resistance of the model. The Hemopump, if not running, can induce substantial regurgitation through the pump into the left ventricle.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Babic, Ankica, 1960-, et al.
(författare)
-
Case Based Reasoning in a Web Based Decision Support System for Thoracic Surgery
- 2013
-
Ingår i: IFMBE Proceedings 41. - Cham : Springer. - 9783319008455 - 9783319008462 ; , s. 1413-1416
-
Konferensbidrag (refereegranskat)abstract
- Case Based Reasoning (CBR) methodology provides means of collecting patients cases and retrieving them following the clinical criteria. By studying previously treated patients with similar backgrounds, the physician can get a better base for deciding on treatment for a current patient and be better prepared for complications that might occur during and after surgery. This could be taken advantage of when there is not enough data for a statistical analysis, but electronic patient records that provide all the relevant information to assure a timely and accurate clinical insight into a patient particular situation.We have developed and implemented a CBR engine using the Nearest Neighbor algorithm. A patient case is represented as a combination of perioperative variable values and operation reports. Physicians could review a selected number of cases by browsing through the electronic patient record and operational narratives which provides an exhaustive insight into the previously treated cases. An evaluation of the search algorithm suggests a very good functionality.
|
|
| 6. |
|
|
| 7. |
- Casimir Ahn, Henrik, et al.
(författare)
-
Long-term left ventricular support in patients with a mechanical aortic valve
- 2013
-
Ingår i: Scandinavian Cardiovascular Journal. - : INFORMA HEALTHCARE, TELEPHONE HOUSE, 69-77 PAUL STREET, LONDON EC2A 4LQ, ENGLAND. - 1401-7431 .- 1651-2006. ; 47:4, s. 236-239
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives. The presence of a mechanical prosthesis has been regarded as an increased risk of thromboembolic complications and as a relative contraindication for a left ventricular assist device (LVAD). Five patients in our center had a mechanical aortic valve at the time of device implantation and were studied regarding thromboembolic complications. Design. Five patients operated upon with an LVAD (1 HeartMate I (TM), 4 HeartMate II (TM)) between 2002 and 2011 had a mechanical aortic valve at the time of implantation. The first patient had a patch closure of the aortic valve. In four patients, the prosthesis was left in place. Anticoagulants included aspirin, warfarin, and clopidogrel. Results. The average and accumulated treatment times were 150 and 752 days, respectively. Three of the five patients showed early signs of valve thrombosis on echo with concomitant valve dysfunction. Four patients were transplanted without thromboembolic events during pump treatment. One patient died from a hemorrhagic stroke after 90 days on the LVAD. Conclusions. The strategy of leaving a mechanical heart valve in place at the time of LVAD implantation in five patients led to valvular thrombosis in three but did not provoke embolic events. It increased the complexity of postoperative anticoagulation.
|
|
| 8. |
- Dahlin, Lars-Göran, et al.
(författare)
-
Impella Used for Hemostasis by Left Ventricular Unloading, in a Case With Left Ventricular Posterior Wall Rupture
- 2008
-
Ingår i: Annals of Thoracic Surgery. - : Elsevier. - 0003-4975 .- 1552-6259. ; 85:4, s. 1445-1447
-
Tidskriftsartikel (refereegranskat)abstract
- Left ventricle wall rupture is a feared complication in mitral valve surgery. We report a combined mitral valve anuloplasty and coronary artery bypass grafting procedure with severe, life-threatening bleeding complication due to left ventricular posterior wall rupture. The patient was successfully treated with a temporary left ventricular assist device to decompress the left ventricle in an attempt to minimize the bleeding, as the patient's condition did not allow standard repair of the left ventricle.
|
|
| 9. |
- Granfeldt, Hans, et al.
(författare)
-
A single center experience with the HeartMate II (TM) Left Ventricular Assist Device (LVAD)
- 2009
-
Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 43:6, s. 360-365
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives. Left ventricular assist devices (LVAD), used in the setting bridge-to-transplantation and destination therapy, for patients with deteriorating severe heart failure are continuously developing. The second generation, the axial flow pumps, have been introduced since some years. Design. Eleven consecutive patients, seven male, with severe heart failure due to ischemic cardiomyopathy (n = 5), dilated cardiomyopathy (n = 5) and cytotoxic ethiology (n = 1) were implanted with the HeartMate-II (TM). They were preoperatively treated with inotropic support (n = 9), ventricular assist device (n = 2) and mechanical ventilation (n = 4). Results. Eight patients were bridged to transplant after median 155 days (range, 65 to 316 days). One patient is ongoing for 748 days, intended for destination therapy. Ten of eleven patients were discharged after median 64 days (range, 40 to 105 days). Four patients were reoperated due to bleeding. Two embolic events were recorded. One perioperative death. Conclusion. Eleven HM-II (TM) LVADs have been implanted in our institution with good early results. Eight patients were successfully bridged to heart transplantation. One patient is intended for destination therapy and is ongoing since November 2006. In these severely ill patients, this technique offers a good chance surviving until heart transplantation. In selected cases the technique also offers the possibility of a permanent support and longevity.
|
|
| 10. |
- Granfeldt, Hans, et al.
(författare)
-
Risk Factor Analysis of Swedish Left Ventricular Assist Device (LVAD) Patients
- 2003
-
Ingår i: Annals of Thoracic Surgery. - : Elsevier. - 0003-4975 .- 1552-6259. ; 76:6, s. 1993-1998
-
Tidskriftsartikel (refereegranskat)abstract
- Background. The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods. All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results. Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions. The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers. © 2003 by The Society of Thoracic Surgeons.
|
|
| 11. |
- Granfeldt, Hans, et al.
(författare)
-
The Linkoping-Lund surgical experience with the HeartMate left ventricular assist system
- 1995
-
Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 59:Suppl. 1, s. 52-55
-
Tidskriftsartikel (refereegranskat)abstract
- Four transplant candidates fulfilling the Food and Drug Administration criteria for a permanent left ventricular assist device received a pneumatic HeartMate system as a bridge to heart transplantation. All patients survived and were fully rehabilitated at the time of transplantation, which was carried out 2 to 6 months after the initial operation. There were no major complications associated with the procedures. We are impressed by the effectiveness and safety of the device.
|
|
| 12. |
- Holmberg, Erica, et al.
(författare)
-
More than 20 years' experience of left ventricular assist device implantation at a non-transplant Centre
- 2017
-
Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 51:6, s. 293-298
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Over recent decades implantable left ventricular assist devices (LVAD) have increased the possibility of improved survival in patients with advanced heart failure who also benefit from a better quality of life. The aim of this retrospective survey was to review the clinical results of LVAD implantation at a low-volume non-transplant centre (Linköping, Sweden) between 1993 and 2016. Our aim was also to assess the mortality and morbidity rates associated with implantation of three LVAD versions at our centre, and to compare our results with those from transplant centres.DESIGN: A retrospective cohort study was performed examining the medical records of patients who had a HeartMate(®) (HMI, HMII, HMIII) LVAD implanted as a bridge to heart transplantation (BTT) or as destination therapy (DT) at the University Hospital, Linköping.RESULTS: Our main finding was a survival to heart transplantation rate of 82% among our BTT LVAD patients. The most common adverse event among our patients was infection. A higher frequency of temporary dialysis was seen in the HMII group compared to the HMI group, and the frequency of right ventricular failure was higher in our HMII material.CONCLUSIONS: Our data suggests that patients requiring long-term LVAD support can safely have their device implanted and cared for at a non-transplant centre.
|
|
| 13. |
- Hubbert, Laila, et al.
(författare)
-
Acoustic Analysis of a Mechanical Circulatory Support
- 2014
-
Ingår i: Artificial Organs. - : Wiley-Blackwell. - 0160-564X .- 1525-1594. ; 38:7, s. 593-598
-
Tidskriftsartikel (refereegranskat)abstract
- Mechanical circulatory support technology is continually improving. However, adverse complications do occur with devastating consequences, for example, pump thrombosis that may develop in several parts of the pump system. The aim of this study was to design an experimental clot/thrombosis model to register and analyze acoustic signals from the left ventricular assist device (LVAD) HeartMate II (HMII) (Thoratec Corporation, Inc., Pleasanton, CA, USA) and detect changes in sound signals correlating to clots in the inflow, outflow, and pump housing. Using modern telecom techniques, it was possible to register and analyze the HMII pump-specific acoustic fingerprint in an experimental model of LVAD support using a mock loop. Increase in pump speed significantly (P less than 0.005) changed the acoustic fingerprint at certain frequency (0-23 000 Hz) intervals (regions: R1-3 and peaks: P1,3-4). When the ball valves connected to the tubing were narrowed sequentially by similar to 50% of the inner diameter (to mimic clot in the out-and inflow tubing), the frequency spectrum changed significantly (P less than 0.005) in P1 and P2 and R1 when the outflow tubing was narrowed. This change was not seen to the same extent when the lumen of the ball valve connected to the inflow tube was narrowed by similar to 50%. More significant (P less than 0.005) acoustic changes were detected in P1 and P2 and R1 and R3, with the largest dB figs. in the lower frequency ranges in R1 and P2, when artificial clots and blood clots passed through the pump system. At higher frequencies, a significant change in dB figs. in R3 and P4 was detected when clots passed through the pump system. Acoustic monitoring of pump sounds may become a valuable tool in LVAD surveillance.
|
|
| 14. |
- Hübbert, Laila, et al.
(författare)
-
Axial flow pump treatment during myocardial depression in calves : an invasive hemodynamic and echocardiographic tissue Doppler study.
- 2008
-
Ingår i: ASAIO journal (1992). - Philadelphia, PA USA : Lippincott Williams & Wilkins. - 1058-2916 .- 1538-943X. ; 54:4, s. 367-371
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to investigate flow characteristics and myocardial function after implantation of an axial pump left ventricular assist device while varying afterload and during progressive myocardial depression. Ten calves were included, seven of which fulfilled the protocol. Invasive hemodynamic monitoring and echocardiography with color-coded systolic tissue Doppler velocity (TD velocity) were used during prepump conditions, at three different pump speeds, during modification of the systemic vascular resistance (SVR), and during increasing degrees of beta-blockade. The TD velocity decreased with the myocardial function whereas left ventricular size, fractional shortening, and pump speed did not correlate significantly with the TD velocity. The TD velocity correlated significantly with native stroke volume, heart rate, SVR and cardiac output but none of these alone could explain more than 20% of the changes in TD velocity. The axial flow pump studied is effective in unloading the severely depressed heart and has a high capacity for maintaining an adequate cardiac output, regardless of differing hemodynamic conditions, pump speed or decreasing LV function. Echocardiography with volumetric rendering and TD velocity imaging are valuable tools for monitoring and quantifying residual myocardial function during pump treatment.
|
|
| 15. |
|
|
| 16. |
- Hübbert, Laila, et al.
(författare)
-
Echocardiography and myocardial Doppler indices in the anesthetized calf : A closed and open chest study
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: the aim of this study was to provide baseline central hemodynamic and echocardiographic values in an anaesthetized calf model before and after sternotomy, and to include tissue Doppler imaging (TDI) modalities so that they may be applied to future anaesthetized calf models in cardiovascular research. Method and results: twenty-one healthy anaesthetized calves were catheterized and invasively and echocardiographic monitored before and after sternotomy using a pulmonary artery catheter, left atrial and carotid artery catheters, and transthoracic or pericardial echocardiography. The following data were registered: heart rate, mean arterial pulmonary and systemic pressures, central venous pressure and saturation, cardiac output, left and right ventricular dimensions and their myocardial regional basal peak velocity and strain rate during systole, early diastolic and atrial filling and systolic peak strain and systolic displacement. After sternotomy, the heart rate, systemic arterial pressure and left ventricular size increased, but other cardiovascular parameters, including echocardiographic myocardial velocities, strain and displacement did not change. Conclusion: transthoracic and pericardial echocardiography including TDI, is feasible and applicable to the anaesthetized calf model. The normal ranges for baseline hemodynamic and echocardiographic variables derived from this study demonstrate that, as in humans, sternotomy influences basic hemodynamic variables such as heart rate, blood pressure and heart volumes but does not significantly affect TDI. The data collected may be useful in the future development of cardiovascular research using the anaesthetized calf model.
|
|
| 17. |
- Hübbert, Laila, et al.
(författare)
-
Second Harmonic Echocardiography and Spontaneous Contrast during Implantation of a left Ventricular Assist Device
- 2010
-
Ingår i: ASAIO journal (1992). - : Wolters Kluwer. - 1058-2916 .- 1538-943X. ; 56:5, s. 417-421
-
Tidskriftsartikel (refereegranskat)abstract
- Implantable mechanical left ventricular assist devices (LVADs) are used as a bridge or alternative to heart transplantation. Peroperative transesophageal echocardiography is commonly applied during implantation. Significant air embolism may occur as a result of air leakage at connections and anastomoses when LV filling becomes inadequate, and this must be prevented. Early suspicion and detection of air is mandatory to avoid negative circulatory effects. We hypothesized that monitoring of heart chamber size and occurrence of single air bubbles using second harmonic imaging (SHI) echocardiography may prevent risk for significant air embolism. After implantation of the LVAD in 10 calves, invasive hemodynamic monitoring and epicardial SHI were performed while increasing pump speed. Air bubbles in the ascending aorta were monitored and the left heart visualized for off-line dimensional analysis. Detection of air bubbles in the ascending aorta preceded their appearance in the left ventricle. They occurred exclusively but not always after a decrease in left atrial (LA) size. Decrease in LA pressure did not predict bubble detection or reduction in LA size. We conclude that SHI detects spontaneous ultrasound contrast during implantation of a LVAD and that a decrease in LA size is a warning that air embolism is imminent.
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
- Peterzén, Bengt, et al.
(författare)
-
Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker
- 1999
-
Ingår i: Journal of cardiothoracic and vascular anesthesia. - 1053-0770. ; 13:4, s. 431-436
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe the clinical protocol regarding monitoring, pharmacologic interventions, and postoperative care during and after coronary artery bypass grafting (CABG) on the beating heart with an axial flow pump and a short-acting β-blocker. Design: A retrospective study. Setting: A university hospital. Participants: Seventeen patients scheduled for elective CABG. Interventions: Invasive monitoring was performed with either a standard pulmonary artery catheter (PAC) or a surgically placed PAC. An axial flow pump was inserted through a graft sutured to the ascending aorta. A short-acting β-blocker was administered to decrease the motion of the heart and make conditions for CABG adequate and safe. Measurements and main results: Compared with baseline measurements, there were significant decreases in mean arterial blood pressure, mixed venous oxygen saturation, and right ventricular ejection fraction during maximal axial flow pump support and β-blockade. No significant change in heart rate was observed at this time. Hemodynamic variables were normalized in the intensive care unit. All patients were separated from the Hemopump without inotropic support, and values of troponin-T, aspartate aminotransferase, and alanine aminotransferase were low postoperatively. All patients survived and were discharged from the hospital. Conclusion: The anesthetic protocol for patients undergoing surgery with a beating heart and the combined use of an axial flow pump and a short-acting β-blocker is outlined. Multiple-vessel CABG on the beating heart was performed with maintenance of an acceptable hemodynamic situation.
|
|
| 21. |
- Peterzén, Bengt, 1949-
(författare)
-
Farmakologisk behandling av svår hjärtsvikt.
- 2002
-
Ingår i: Farmakologisk behandling av svårt hjärtsvikt (Svenskt kardiovaskulärt vårmöte, Malmö),2002.
-
Konferensbidrag (refereegranskat)
|
|
| 22. |
|
|
| 23. |
|
|
| 24. |
- Peterzén, Bengt, 1949-
(författare)
-
Management of patients treated with left ventricular assist devices : A clinical and experimental study
- 2001
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis describes the management of patients treated with mechanical circulatory support devices for short- or long-term use. Twenty-four patients suffering from postcardiotomy heart failure were treated with a minimally invasive axial flow pump. The device was effective in unloading the failing left ventricle and in maintaining an adequate systemic circulation. The principles of perioperative monitoring, and pharmacological therapy are outlined. The pump was also used as an alternative to the heart-lung machine in conjunction with coronary artery bypass surgery. Together with a short-acting β-blocker, esmolol, the heart was decompressed and heart motion was reduced, facilitating bypass surgery on the beating heart. The anesthesiological considerations using this method are described.An implantable left ventricular assist device was used as a bridge to heart transplantation in 10 patients. We were interested in assessing the possibility to establish such a treatment program at a non-transplanting center. A multidisciplinary approach was enabled thanks to the organization of our Heart Center and due the close collaboration with our transplant center at Lund University. As one of the first centers in Europe, we established a well-functioning program with good results. Nine out of 10 of the bridge patients, with treatment times varying between 53 to 873 days, survived pump treatment and were eventually transplanted. The device proved to be powerful enough to support the failing heart and enable rehabilitation of the patients. Outpatient management became simpler when using the electrical device with belt-worn batteries. The uncertain durability and the high risk of device-related complications are shortcomings that limit its potential for more permanent treatment of heart failure.A new generation of small implantable axial blood flow pumps has therefore been developed. The principles of these pumps are based on the first generation axial flow pumps evaluated in this thesis. After several years of basic research and experimental studies, the first human implants have been performed. In the thesis, the hemodynamic effects of such a novel axial flow pump have been evaluated in an acute heart failure model. This technology holds great promise, both as a bridge to heart transplantation, and as a permanent circulatory support system.
|
|
| 25. |
- Peterzén, Bengt, et al.
(författare)
-
Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center
- 2000
-
Ingår i: Journal of cardiothoracic and vascular anesthesia. - : Elsevier BV. - 1053-0770. ; 14:4, s. 438-443
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center. Design: A prospective study from February 1993 to June 1999. Setting: A university hospital. Participants: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3). Interventions: The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period. Measurements and Main Results: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended. Conclusions: The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.
|
|
| 26. |
|
|
| 27. |
- Peterzén, Bengt, et al.
(författare)
-
Postoperative management of patients with Hemopump support after coronary artery bypass grafting
- 1996
-
Ingår i: The Annals of thoracic surgery. - 0003-4975. ; 62:2, s. 378-385
-
Tidskriftsartikel (refereegranskat)abstract
- Background In this study, we describe postoperative monitoring, pharmacologic therapy, and hemodynamic responses in patients receiving Hemopump support after postcardiotomy heart failure. Methods The Hemopump was used in 24 patients with severe left ventricular dysfunction after coronary artery bypass grafting. Results Fourteen patients (58%) were weaned from the Hemopump. Low to moderate doses of a combination of catecholamines, phosphodiesterase inhibitors, vasodilators, and vasoconstrictors were required to optimize Hemopump function and left ventricular unloading. Mean arterial blood pressure, mixed venous oxygen saturation, and urinary output were the most important therapy guidelines. Conclusions Together with our clinical protocol, the Hemopump effectively unloaded the failing ventricle while maintaining vital-organ perfusion. Doses of vasoactive drugs could be kept low. This approach to treatment provides good conditions for recovery of the stunned myocardium.
|
|
| 28. |
- Peterzén, Bengt, et al.
(författare)
-
Response : Is an axial flow pump necessary during beating heart surgery? Volume14, Issue 3, p. 361
- 2000
-
Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : Elsevier. - 1053-0770 .- 1532-8422. ; 14:3, s. 3611-361
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- We thank Dr D'Ancona and coworkers for their comments regarding our previous article.1 The reasons for the combined use of an axial flow pump and β-blocker during bypass surgery are two: (1) This is one of many techniques to perform coronary artery bypass graft surgery on the beating heart. Few alternatives, including mechanical stabilizers, were available when this study began. The development in this area of cardiac surgery and anesthesia has been rapid. All this work is a part of an evolutionary process. (2) In some patients, it still can be difficult to perform bypass graft surgery on the posterior part of the heart. In these situations, the technique described by us could be an alternative. We do not state that this is a necessary technique for grafting of the circumflex system; it should be regarded as an option if the global circulation does not tolerate an off-pump technique....
|
|
| 29. |
|
|
| 30. |
- Sundbom, Per, et al.
(författare)
-
Young Woman With Breast Cancer and Cardiotoxicity With Severe Heart Failure Treated With a HeartMate II (TM) for Nearly 6 Years Before Heart Transplantation
- 2014
-
Ingår i: ASAIO journal (1992). - : Lippincott, Williams andamp; Wilkins. - 1058-2916 .- 1538-943X. ; 60:6, s. E3-E4
-
Tidskriftsartikel (refereegranskat)abstract
- Cardiotoxicity is a multifactorial problem, which has emerged with the improvement of cancer therapies and survival. Heart transplantation is relatively contraindicated in patients with breast cancer, until at least 5 years after complete remission. We present a case where a young woman who in 2001, at the age of 31, was diagnosed with breast cancer. She was considered cured, but 4 years later she suffered a relapse. During her second treatment, in 2006, she suffered from severe heart failure. She received a HeartMate II, as a long-term bridge to transplantation and 6 years later she was successfully transplanted. In this case report we discuss the use of mechanical circulatory support in cancer patients with drug-induced heart failure.
|
|
| 31. |
- Valadkhani, Arman, et al.
(författare)
-
Postoperative complications and myocardial injury in patients receiving air or oxygen. Prospective, randomised and pilot study
- 2022
-
Ingår i: Acta Anaesthesiologica Scandinavica. - : WILEY. - 0001-5172 .- 1399-6576. ; 66:10, s. 1185-1192
-
Tidskriftsartikel (refereegranskat)abstract
- Background Supplementary oxygen is administered during anaesthesia to increase oxygen delivery and prevent hypoxia. Recent studies have questioned this routine. In this pilot study, our main aim was to investigate if 21% oxygen compared to >= 50% reduces the risk of postoperative complications and myocardial injury. Methods In this pragmatic, multicentre, single-blind study, patients undergoing vascular surgery were randomised to receive a fraction of inspired oxygen (FiO2) >= 0.50 and oxygen saturation determined by pulse oximetry (SpO(2)) >= 98% (group H) or FiO2 of 0.21 and SpO(2) > 90% (group N) oxygen perioperatively. The primary outcome was a composite outcome of major pre-defined postoperative complications assessed at 30 days. Myocardial injury was determined by serial troponin measurements. Data were analysed using generalised estimating equation, Mann-Whitney U test or chi-squared test, as appropriate. Results The 191 patients were randomised, and per-protocol principle was used for analyses. At 30-day follow-up, 43 out of 94 patients (46%) had a postoperative complication in group H and 36 out of 90 patients (40%) in group N, p = .46. New myocardial injury was seen in 27% versus 22% in Groups H and N respectively (p = .41). No differences in other outcomes were observed between the groups. Twelve patients (13%) in Group N had SpO(2) < 90%, six recovered spontaneously and six required supplemental oxygen. At 1-year follow-up, one patient in group H had died. Conclusion In this pilot study, postoperative complications were similar between the groups in patients randomised to FiO2 of 0.21 or >= 0.50 and no difference was found in the incidence of new myocardial injury. Larger, prospective adequately powered studies are needed.
|
|
| 32. |
- Wårdell, Karin, 1959-, et al.
(författare)
-
Circulatory response of cardiac assist treatment
- 2000
-
Ingår i: European Conference on Microcirculation,2000. - Bologna, Italy : Monduzzi Editore, International Proceedings Division. - 9783805571227 - 9783318006209
-
Konferensbidrag (refereegranskat)
|
|
