Browsing by Author "Makdisi, George"

Now showing 1 - 8 of 8
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    Extra Corporeal Membrane Oxygenation (ECMO) review of a lifesaving technology
    (AME Publishing Company, 2015-07) Makdisi, George; Wang, I-wen; Department of Medicine, IU School of Medicine
    Extra Corporeal Membrane Oxygenation (ECMO) indications and usage has strikingly progressed over the last 20 years; it has become essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional management. In this article we will provide a review of ECMO development, clinical indications, patients' management, options and cannulations techniques, complications, outcomes, and the appropriate strategy of organ management while on ECMO.
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    How to establish a successful ex vivo lung perfusion program
    (AME, 2017-05) Makdisi, George; Wozniak, Thomas C.; Medicine, School of Medicine
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    Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation
    (Pioneer Bioscience Publishing Company, 2015-11) Makdisi, George; Hashmi, Zubair A.; Wozniak, Thomas C.; Wang, I.-Wen; Department of Surgery, IU School of Medicine
    Extra corporeal membrane oxygenation (ECMO) has remarkably progressed over the recent years. It has become an invaluable tool in the care of adults and pediatric patients with severe cardiogenic shock. At the initiation of ECMO support, the left ventricular contractility is profoundly impaired. Inadequate right ventricular drainage and bronchial circulation can lead to left ventricular distension, with potential deleterious consequences, ranging from inadequate myocardial rest, pulmonary edema, or intracardiac clot formation. Therefore, it is of extreme importance to ensure an adequate left ventricular drainage. Here we present a case of LV thrombus developed while the patient is on central venoarterial (VA) ECMO.
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    Minimally invasive is the future of left ventricular assist device implantation
    (Pioneer Bioscience Publishing Company, 2015-09) Makdisi, George; Wang, I.-Wen; Department of Surgery, IU School of Medicine
    There have been many factors that have allowed for progressive improvement in outcomes and lower complication rates. These include the improvement in left ventricular assist device (LVAD) technologies, combined with better understanding of patient management, all these. Nowadays the numbers of LVAD implantations exceed the number of annual heart transplants worldwide. Minimally invasive procedures are shown to improve the surgical outcome in both LVAD insertion and replacement. These minimally invasive techniques can be grouped grossly into shifting from on-pump to off-pump implantation, alternative access for implantation other than sternotomy, and a combination of both, which should be the ultimate aim of minimally invasive LVAD implantation. Here we describe the alternative techniques and configurations of minimally invasive and sites of implantation.
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    Severe epistaxis in patients on extracorporeal membranous oxygenator support occurrence and management
    (Pioneer Bioscience Publishing Company, 2015-11) Makdisi, George; Wang, I.-Wen; Department of Surgery, IU School of Medicine
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    A successful percutaneous mechanical vegetation debulking used as a bridge to surgery in acute tricuspid valve endocarditis
    (The Society for Thoracic Disease, 2016-01-29) Makdisi, George; Casciani, Thomas; Wozniak, Thomas C.; Roe, David W.; Hashmi, Zubair A.; Department of Radiology and Imaging Sciences, IU School of Medicine
    Timing of surgical management of acute infective endocarditis is a major challenge, with respect to surgical complications, risks of recurrences and optimal valve repair or replacement. We present a case of a 24-year-old male with a history of intravenous drug abuse, who was referred to our center after 10 days of medical management of acute infective endocarditis. Upon arrival he was in septic shock, multi-organ failure, and mobile vegetations on the tricuspid valve with severe tricuspid regurgitation. He also had bilateral pulmonary infarcts and an ischemic stroke in the right parietal lobe. A successful percutaneous transcatheter mechanical vegetation debulking was performed followed by surgical valve replacement seven days later. This case introduces a new option in the management of right-sided endocarditis in critically ill patient, and demonstrates the technical feasibility of a debulking procedure in this setting, which led subsequently to a significant improvement in patient’s condition, and he was ultimately able to undergo definitive surgery.
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    Use of distal perfusion in peripheral extracorporeal membrane oxygenation
    (AME, 2017-03) Makdisi, George; Makdisi, Tony; Wang, I-Wen; Department of Medicine, IU School of Medicine
    Extra corporeal membrane oxygenation (ECMO) is a life-saving technique to manage refractory cardiopulmonary failure. Its usage and indication continue to increase. Femoral venoarterial ECMO (VA ECMO) is relatively less invasive and the cardiac support may be more rapidly instituted in in these extremely tenuous patients. Vascular injuries and limb ischemia unfortunately occur in these emergent access settings. Here we will discuss the optimal techniques of preventing this complication which might affect patient survival and impact the patient quality of life.
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    Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement
    (AME, 2016-08) Makdisi, George; Makdisi, Peter B.; Wang, I-Wen; Department of Medicine, IU School of Medicine
    The superiority of transcatheter aortic valve replacement (TAVR) compared with medical therapy for patients with aortic stenosis (AS) who are not suitable candidates for surgery had been proven. Cardiopulmonary bypass (CPB) is rarely used in TAVR. Reports of early use of extracorporeal membranous oxygenator (ECMO) have promising outcomes. ECMO offers the option of cardiac support rescue in case of intraoperative hemodynamic instability and can be instituted in advance when hemodynamic instability is expected. Here we review the English literature about the use of ECMO in TAVR procedures, and discuss the indications and rationale for its use as well as its advantages.