Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2019
Late surgical conversions after abdominal endovascular aortic repair: underlying mechanisms, clinical results and strategies for prevention.
Our goal was to report our results of late surgical conversion after endovascular aneurysm repair (EVAR). ⋯ Despite being a challenging operation, late surgical conversion after EVAR yields excellent results with regard to outcome and freedom from the need for further aortic interventions. An anticipative strategy adhering to current recommendations for using or refraining from using EVAR in patients with anatomical challenges will help reduce the need for secondary surgical conversions and keep them to minimum.
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Interact Cardiovasc Thorac Surg · Dec 2019
Tranexamic acid and convulsive seizures after off-pump coronary artery bypass surgery: the role of renal insufficiency.
There is evidence that, in adult cardiac surgical patients undergoing on-pump procedures, tranexamic acid (TXA) dose-dependently increases the risk of convulsive seizure (CS). We aimed to investigate whether a single TXA bolus of 1 g influences the risk of CS in patients who were operated on without the use of cardiopulmonary bypass. In 2249 propensity-score-matched pairs who underwent off-pump coronary artery bypass grafting with or without TXA administration, the risk of CS was 0.5% and 0.3% in the TXA and non-TXA groups, respectively (P = 0.36). ⋯ The risk of stroke, in-hospital mortality and 30-day mortality did not differ significantly between study groups (P-value >0.05). Our data indicate that in patients undergoing off-pump coronary artery bypass grafting, a single TXA bolus of 1 g generally does not increase the risk of CS. However, the presence and extent of renal insufficiency have a very significant impact on the incidence of CS even after single-dose TXA.
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Interact Cardiovasc Thorac Surg · Dec 2019
Patterns of aortic remodelling after total arch replacement with frozen elephant trunk for acute aortic dissection.
We investigated the outcomes of total arch replacement with frozen elephant trunk (FET) for Stanford type A acute aortic dissection and the patterns of postoperative aortic remodelling from computed tomographic (CT) findings. ⋯ We investigated the patterns of aortic remodelling after total arch replacement with FET for Stanford type A aortic dissection from postoperative CT findings. Regardless of the position of the most proximal tear in the descending aorta, aortic remodelling did not occur as long as the most proximal tear was located in the descending aorta. When the most proximal tear occurred in the descending aorta, TEVAR as a pre-emptive treatment can be effective in preventing postoperative aortic adverse events.
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Interact Cardiovasc Thorac Surg · Dec 2019
Outcomes of mitral valve repair in acute native mitral valve infective endocarditis.
Mitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis. ⋯ Although MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.
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Interact Cardiovasc Thorac Surg · Nov 2019
Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection.
The aim of this study was to evaluate the outcomes of the frozen elephant trunk (FET) technique, using the J Graft FROZENIX for Stanford type A acute aortic dissection, in comparison with the unfrozen elephant trunk technique. ⋯ Total arch replacement with the FET technique in Stanford type A acute aortic dissection carries a risk of distinct complications; however, with thorough advance planning, it should be possible to safely institute this treatment. Further randomization, with a comparison of each technique, is required to provide clear conclusions whether the FET is useful for acute Stanford type A aortic dissection.