Assessment of image quality of repeated focused transthoracic echocardiography after cardiac surgery
David CantyJohan HeibergJason TanYuxin YangAlistair RoyseColin RoyseAbdulelah F. Al MobeirekFayez El ShaerHanan AlbackrRakan I. NazerMoustafa M.G. FoudaB. M. BakirAhmed A. Alsaddique
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Extracorporeal membrane oxygenation offers temporary hemodynamic support for patients with refractory cardiogenic shock after cardiovascular surgery. However, the initiation time for such patients is controversial. Changing the initiation time might improve the outcomes. This study aimed to investigate whether early extracorporeal membrane oxygenation could improve postoperative outcomes in patients at a high risk of cardiogenic shock. In this retrospective study, 173 patients with cardiovascular diseases at a high risk of refractory cardiogenic shock which assessed via empirical risk evaluation from 2010 to 2017 were included. After propensity matching, 36 patients, who were matched to patients initiated with extracorporeal membrane oxygenation after cardiovascular operation (delayed extracorporeal membrane oxygenation group, n = 36), were also initiated with such early in the operating room (early extracorporeal membrane oxygenation group, n = 36). The primary outcome was death. The secondary outcomes included receiving continuous renal replacement therapy, ventricular arrhythmia, and pulmonary infection. The demographic and baseline variables were similar between the matched groups. The early extracorporeal membrane oxygenation group showed lower mortality (69.44% vs 41.67%, P = 0.03), pulmonary infection morbidity (86.11% vs 55.56%, P < 0.01), and continuous renal replacement therapy rate(88.89% vs 66.67%, P = 0.04). Moreover, they showed improved cardiac index (P = 0.01) and lactate clearance (P < 0.01). Extracorporeal membrane oxygenation provides effective support for cardiogenic failure refractory to medical management; early initiation improves cardiac output and promotes lactate clearance, thus increasing survival in patients with cardiogenic shock after cardiovascular surgery. This is a retrospective study. It was not registered.
Cardiothoracic surgery
Extracorporeal
Extracorporeal circulation
Vascular surgery
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Cardiothoracic surgery
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A review of extracorporeal membrane oxygenation in child after cardiac surgery: analyses of outcomes
Results Age and weight were 12 ± 17months and 6.4 ± 3.3kg, respectively. Twenty patients had single ventricle and 38 had biventricular physiology. The duration of ECMO was 8.4 ± 4.4 days. Fifty-two (84%) were successfully weaned off ECMO and 34 (55%) survived to hospital discharge. The weaning from ECMO was affected by peak serum lactate during ECMO (risk ratio = 1.02, 95% CI: 1.003-1.036, p = 0.0181) and the diagnosis of isomerism (46, 0.0004-0.41, 0.0085) by multivariate analysis. Indication for ECMO and surgical procedures were not significant predictors. Factors associate with failure of hospital discharge despite successful decannulation were as follows: weight (0.32, 0.14-0.62, 0.0001), ECMO duration (1.3, 1.02-1.72, 0.0352), the duration of the day between decannulation and the first day of negative water balance after ECMO (1.3, 1.13-1.54, 0.0001), the use of nitric oxide gas after ECMO (8.4, 1.81-46.66, 0.0068). Survivor vs. non-survivor to the hospital discharge was 7.1 ± 4.1 vs. 10.0 ± 4.2 (days) in ECMO duration (p = 0.0073) and 2.1 ± 1.5 vs. 8.3 ± 10.2 (days) in the negative water balance (p = 0.0004).
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To evaluate the ability of low radiation dose dual-source computed tomography (DSCT) to depict the features of morphological univentricular heart and to define accuracy by comparing findings with surgery. Low radiation dose dual-source cardiac computed tomography (CCT) of 33 cases of functional univentricular heart preliminary diagnosis by echocardiography compared with the results of surgery were retrospectively analyzed (aged 1 day to 4 years, median 5 months). The appropriate dose reduction strategies and iterative reconstruction were applied. Thirty three univentricular heart patients were classified into three types according to Anderson’s classification method, including 16 cases (48.5%) univentricular of right ventricular type with rudimentary chamber of left ventricle, 11 cases (33.3%) univentricular of left ventricular type with rudimentary chamber of right ventricle and 6 cases (18.2%) univentricular heart of indeterminate type without rudimentary chamber. The extracardiac malformation such as hypoplastic aortic arch, coronary artery fistula, total anomalous pulmonary venous returns or hypoplastic lung were presented frequently. The overall sensitivity and specification of cardiac CT was 100% compared to the results of surgery. The procedural dose-length product was 18 ± 5 mGy-cm, and unadjusted and adjusted radiation doses were 0.25 and 0.64 mSv, respectively. Cardiac CT can diagnose accurately and be performed with a low radiation exposure in patients with the functional univentricular heart disease. The aorta, pulmonary artery and lung can be evaluated completely and simultaneously as well. Cardiac CT is an effective advanced non-invasive imaging modality to comprehensive evaluation the functional univentricular heart patients, particularly if cardiac MRI poses a high risk or is contraindicated.
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