RESUMO
PURPOSE: Extracorporeal membrane oxygenation (ECMO) support is a widely accepted treatment option for patients with cardiogenic shock, but it is still related to a high incidence of severe complications and death. We present an alternative implantation technique to prevent life-threatening vascular complications.â© METHODS: Between January 2008 and January 2011, a total of 28 patients with acute myocardial failure and consecutive cardiogenic shock required ECMO as supportive treatment. Pre-implantation procedures were isolated CABG, CABG combined with mitral valve reconstruction or ventricular septal defect closure, respectively. The implantation of ECMO was performed by connecting the ascending aorta via an 8 mm Dacron prosthesis with the arterial line and percutaneous puncture of the femoral vein. The chest was closed after installation of ECMO was completed. The arterial line was directed subxyphoidally and removal was possible without thoracotomy.â© RESULTS: Average support duration was 8.7 ± 3.9 days. An additional intra-aortic balloon pump was used in 23 patients (89.3%). Cerebrovascular events occurred in 21.4% and gastrointestinal complications in 9.1%. Acute renal failure was treated with continuous renal replacement therapy in 64.3%. In eight cases a systemic infection had to be treated. One patient with pre-existing severe peripheral arterial disease suffered from limb malperfusion, requiring leg amputation. Twelve patients were successfully weaned from ECMO and 8 patients (28.6%) were discharged from hospital. â© CONCLUSIONS: This alternative cannulation strategy offers effective cardiopulmonary support while minimizing the risk of limb hypo- or hyperperfusion without requiring reopening of the thorax.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/cirurgia , Balão Intra-Aórtico/métodos , Isquemia/prevenção & controle , Perna (Membro)/irrigação sanguínea , Choque Cardiogênico/cirurgia , Idoso , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Insuficiência Cardíaca/complicações , Humanos , Balão Intra-Aórtico/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/complicações , Resultado do TratamentoRESUMO
The problem of symptomatic, diffuse coronary artery disease not amenable to the established methods of medical or revascularizing therapies remains unsolved. Aortocoronary venous bypass grafting is a rare treatment modality bearing considerable risks. We report on a further complication of the method.
Assuntos
Aneurisma/etiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/etiologia , Hipertensão Pulmonar/etiologia , Veia Safena/patologia , Aneurisma/cirurgia , Cateterismo Cardíaco , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Humanos , Hipertensão Pulmonar/cirurgia , Masculino , Pessoa de Meia-Idade , Veia Safena/cirurgia , Veia Safena/transplante , Técnicas de Sutura , ToracotomiaRESUMO
Ventricular wall rupture after mitral valve replacement is an infrequent but dreaded complication. We have experienced this problem in two separate instances of type III left ventricular rupture and report the successful repair by a novel technique with the use of a new sealant, the AdvaSeal (FocalSeal), in a sandwitch repair procedure.