The Annals of thoracic surgery
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Penetrating aortic ulcers (PAU) often occur in a debilitated elderly population. Although early results of repair for PAU are well described, late outcomes remain poorly characterized and are the focus in this report. ⋯ Despite the presence of an older, more complex TEVAR group, late outcomes after repair for PAU were affected more by age and type of presentation than by treatment strategy. Recognizing the perils of intervention in this high-risk population, TEVAR emerges as the therapy of choice to reduce early morbidity and provide similar late survival.
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Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are very few studies that adequately assess the long-term survival. This study was undertaken to evaluate the effects of transfusion on both short-term and long-term survival after cardiac surgery. ⋯ This study suggests that blood or blood product transfusion during or after cardiac surgery is associated with increased short-term and long-term mortality. It reinforces the need for prospective randomized controlled studies for evaluation of restrictive transfusion triggers and objective clinical indicators for transfusion in the cardiac surgical patient population.
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Even if the thoracic endovascular aortic repair or open stent grafting technique becomes popular, surgical total arch replacement is still important and will continue to be necessary. Distal anastomosis of total arch replacement is critical in this procedure. This article describes an easy and useful method for using a malleable retractor ring in the distal anastomosis of the total arch replacement.
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Sutureless aortic bioprostheses bear the potential of easy implantation, reduced ischemic time, and surgical trauma in aortic valve replacement. We herein show our clinical and echocardiographic results after a 1-year experience with a new sutureless bioprosthesis. ⋯ The Perceval S shows satisfactory clinical and hemodynamic results. Due to its simple implantation technique, it represents an alternative especially for minimally invasive surgery. Operative trauma can be minimized by short aortic cross-clamp time.
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We reviewed our experience with valve-sparing aortic root reconstruction (VSARR) using the sinus of Valsalva graft in children, teenagers, and young adults with connective tissue disorders. ⋯ VSARR using the sinus of Valsalva graft is a reproducible technique that achieves acceptable early and intermediate results. It is suitable for children, teenagers, and young adults. Anticoagulation is avoided. The procedure is appropriate for emergency operations but should be used with caution in patients with a bicuspid aortic valve.