The Annals of thoracic surgery
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The need for reoperation remains a principal limitation of the Ross procedure and most commonly includes replacement of the neo-aortic valve. We describe the use of a valve-sparing procedure in a patient with progressive dilatation of the pulmonary autograft and the remaining native ascending aorta and mild regurgitation of the neo-aortic valve.
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This retrospective analysis of a selected series of Bentall procedures may be useful in evaluating the results of valve-sparing operations, an increasingly popular alternative for replacement of the ascending aorta and aortic valve. ⋯ The button Bentall procedure can be performed with excellent short-term and long-term results in relatively uncomplicated elective patients in whom aortic valve disease is combined with dilatation of the ascending aorta. Results of this traditional operation are the standard against which the long-term outcome of newer approaches, such as valve-sparing operations, should be compared.
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Comparative Study
Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion.
The optimal therapy for symptomatic pericardial effusions remains controversial. This paper compares outcomes after the two most commonly used techniques, percutaneous catheter drainage and operative subxiphoid pericardial drainage. ⋯ Subxiphoid and percutaneous pericardial drainage of symptomatic pericardial effusions can be performed safely; however, death occurs from underlying disease. Open subxiphoid pericardial drainage with pericardial biopsy appears to decrease recurrence but does not improve diagnostic accuracy of malignancy over cytology alone.
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Acute renal injury is a common serious complication of cardiac surgery. Moderate hemodilution is thought to reduce the risk of kidney injury but the current practice of extreme hemodilution (target hematocrit 22% to 24%) during cardiopulmonary bypass (CPB) has been linked to adverse outcomes after cardiac surgery. Therefore we tested the hypothesis that lowest hematocrit during CPB is independently associated with acute renal injury after cardiac surgery. ⋯ These results add to concerns that current CPB management guidelines accepting extreme hemodilution may contribute to postoperative acute renal and other organ injury after cardiac surgery.