Commentary: Great ideas come from the heart Holman, William L.
The Journal of thoracic and cardiovascular surgery,
December 2022, 2022-12-00, 20221201, Letnik:
164, Številka:
6
Journal Article
Right ventricular failure (RVF) increases morbidity and mortality. The RECOVER RIGHT study evaluated the safety and efficacy of a novel percutaneous right ventricular assist device, the Impella RP ...(Abiomed, Danvers, MA), in a prospective, multicenter trial.
Thirty patients with RVF refractory to medical treatment received the Impella RP device at 15 United States institutions. The study population included 2 cohorts: 18 patients with RVF after left ventricular assist device (LVAD) implantation (Cohort A) and 12 patients with RVF after cardiotomy or myocardial infarction (Cohort B). The primary end point was survival to 30 days or hospital discharge (whichever was longer). Major secondary end points included indices of safety and efficacy.
The patients (77% male) were a mean age of 59 ± 15 years, 53% had diabetes, 88.5% had a history of congestive heart failure, and 37.5% had renal dysfunction. Patients were on an average of 3.2 inotropes/pressors. Device delivery was achieved in all but 1 patient. Hemodynamics improved immediately after initiation of Impella RP support, with an increase in cardiac index from 1.8 ± 0.2 to 3.3 ± 0.23 liters/min/m(2) (p < 0.001) and a decrease in central venous pressure from 19.2 ± 4 to 12.6 ± 1 mm Hg (p < 0.001). Patients were supported for an average of 3.0 ± 1.5 days (range, 0.5-7.8 days). The overall survival at 30 days was 73.3%. All patients discharged were alive at 180 days.
In patients with life-threatening RVF, the novel percutaneous Impella RP device was safe, easy to deploy, and reliably resulted in immediate hemodynamic benefit. These data support its probable benefit in this gravely ill patient population.
Midway through the 20th century, direct open-heart operations were not yet a reality, awaiting safe methods to support the cardiopulmonary circulation during cardiac surgery. The scientific ...advancements collectively leading to safe cardiopulmonary bypass are considered some of the most impactful advances of modern medicine. Stimulated by the work of physiologists and engineers in the late 19th century, primitive pump and oxygenator designs were the forerunners of major work by DeBakey and others in roller pump design and by Gibbon in oxygenator development. Following Gibbon's historic successful closure of an atrial septal defect in 1953 with his heart-lung machine, it was left to Lillehei and Kirklin to first successfully repair large series of cardiac malformations. The history leading to these historic events and the subsequent evolution of cardiopulmonary bypass machines for short- and longer-term support is filled with engineering and surgical brilliance, daring innovations, and serendipity.
Commentary: Chase perfection to catch excellence Holman, William L.; Davies, James E.
The Journal of thoracic and cardiovascular surgery,
February 2023, 2023-02-00, 20230201, Letnik:
165, Številka:
2
Journal Article
The development of devices for cardiac and pulmonary support is an example of innovation that opened important therapeutic options for patients with life-limiting diseases. The history of this ...important advance provides guidance for future developments in the field. Integrity is fundamental to maintaining the trust necessary for success.
The development of devices for cardiac and pulmonary support is an example of innovation that opened important therapeutic options for patients with life-limiting diseases. The history of this ...important advance provides guidance for future developments in the field. Integrity is fundamental to maintaining the trust necessary for success.
Commentary: A problem well put is half solved Holman, William L.; Tallaj, Jose A.; Pamboukian, Salpy V.
The Journal of thoracic and cardiovascular surgery,
August 2023, 2023-Aug, 2023-08-00, 20230801, Letnik:
166, Številka:
2
Journal Article
Commentary: Fast is fine, but accurate is essential Holman, William L.; Vardas, Panayotis N.; Davies, James E.
The Journal of thoracic and cardiovascular surgery,
March 2023, 2023-03-00, 20230301, Letnik:
165, Številka:
3
Journal Article
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