Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Jul 2011
ReviewAortic arch debranching: advanced and hybrid techniques.
Aortic arch procedures have traditionally involved complex surgery with increased risk of mortality and morbidity. Throughout the last decade, however, novel and safe surgical approaches aimed at debranching the great vessels with definitive aortic arch repair have been developed. ⋯ In the future, aortic pathology may also benefit from the development of branched and fenestrated endografts that would be deployed in a modular fashion. This article describes the rationale, procedural steps, and recent outcomes data of novel aortic arch procedures.
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The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle cells, and growth factors and how they affect aortic wall homeostasis. These predeterminants are influenced by smoking, hypertension, and atherosclerosis, and the result in an inflammatory response coupled to an accelerated proteolytic cascade that disrupts both elastin and collagen in the aortic wall.
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Congenital heart disease is the most common birth defect, with an estimated incidence of moderate to severe disease of 4-6 per 1,000 live births. Due to the dramatic advances in cardiac surgery and general pediatric cardiology care, approximately 85% of neonates with congenital heart disease (CHD) survive to adulthood. The most recent information, published in 2004, estimated 787,800 to 1.3 million adults with CHD living in the United States. ⋯ Thus, as survival in this complex portion of the CHD population improves, the number of adult patients with previous Fontan palliation will dramatically increase. The goal of this article is to provide a brief background of the Fontan procedure and then discuss the late-term outcomes and complications in this unique patient type. The majority of the article will focus on information needed to adequately care for the adult Fontan patient.
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Methodist Debakey Cardiovasc J · Apr 2011
ReviewPreventing healthcare-associated infections in cardiac surgical patients as a hallmark of excellence.
Healthcare-associated infections (HAI) are the tenth-leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) estimate that HAIs annually account for 1.7 million infections, 99,000 associated deaths, and a cost of approximately $30 billion. Nonreimbursement of some of these HAIs by the Centers for Medicare and Medicaid Services, public reporting of data (currently in 27 states), and the statistics listed above are driving quality initiatives to reduce or eliminate HAIs. ⋯ This combination makes our patients more vulnerable to HAIs. Accordingly, in 2010 the Society of Cardiovascular Anesthesiologists (SCA) Foundation launched the FOCUS (Flawless Operative Cardiovascular Unified Systems) Cardiac Surgery Patient Safety Initiative to help eliminate infections in cardiac surgery patients, especially catheter-related infections. This publication will briefly discuss the four most common infections and strategies to reduce HAIs and will touch on some of the infection-control experiences from the Methodist DeBakey Heart & vascular Center (MDHVC).
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Methodist Debakey Cardiovasc J · Apr 2011
ReviewElectrophysiology issues in adult congenital heart disease.
Improved surgical outcomes in children have led to a growing population of adults with congenital heart disease. Rhythm disturbances in the adult congenital heart disease (ACHD) patient can be intrinsic to the anomaly or acquired after palliation. Tachyarrhythmias, either supraventricular or ventricular, and bradyarrhythmias, either sinus node dysfunction or atrioventricular block, may occur frequently. ⋯ Other advances include paying careful attention to minimizing ventriculotomies in ToF and ventricular septal defect (VSD) repairs, earlier complete repairs, and valve sparing to reduce pulmonary insufficiency. Finally, completion of the extra-cardiac Fontan procedure (e.g., total cavopulmonary connection) for single ventricles avoids extensive suture lines in the right atrium, thereby reducing scarring and higher pressures that lead to IART and sinus node dysfunction. Extracardiac (EC) conduits and lateral tunnel (LT) Fontans are preferred today, and the Fontan conversion procedure (converting prior atriopulmonary Fontans to the EC or LT type) can be performed to reduce arrhythmia and thromboembolic events.