The Annals of thoracic surgery
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Randomized Controlled Trial
Leaflet reconstructive techniques for aortic valve repair.
Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair. ⋯ Leaflet defects are common in patients with moderate to severe AI. Leaflet plication, nodular unfolding, and double pericardial patching performed well. Gore-Tex and leaflet extension seemed less satisfactory. Standardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair.
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Multicenter Study
Survival benefit of lung transplantation for chronic obstructive pulmonary disease in Sweden.
Lung transplantation (LTx) is a therapeutic option for patients with life-threatening chronic obstructive pulmonary disease (COPD) that is refractory to conventional therapies. The survival benefit of LTx for COPD is difficult to assess. The aim of this study was to evaluate the Swedish series of LTx performed to treat COPD and to identify differences in outcome between COPD related to severe alpha-1-antitrypsin deficiency (AATD) and COPD with normal alpha-1-antitrypsin (AAT) levels. ⋯ Survival after LTx is significantly better for patients with severe AATD and end stage COPD than for the patients with COPD related to cigarette smoking.
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Comparative Study
Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation.
The intraoperative use of cardiopulmonary bypass (CPB) in lung transplantation has been associated with increased rates of pulmonary dysfunction and bleeding complications. More recently, extracorporeal membrane oxygenation (ECMO) has emerged as a valid alternative method of support and has been our preferred method of support since March 2012. We compared early and midterm outcomes of these 2 support methods. ⋯ The use of ECMO in lung transplant is safe and in our experience was associated with decreased rates of pulmonary and renal complications, as compared with CPB. Extracorporeal membrane oxygenation has become our preferred method of intraoperative support during lung transplantation.
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Multicenter Study
Association of center volume with outcomes: analysis of verified data of European Association for Cardio-Thoracic Surgery Congenital Database.
The relation between surgical volumes and outcome in congenital heart surgery (CHS) was investigated with no clear conclusions. We sought to quantify the relationship between surgical volume and surgical performance defined as the relation between outcome and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Score and The Society of Thoracic Surgeons (STS) Morbidity Score. ⋯ Our analysis suggests that after adjustment for case mix higher programmatic volume is associated with lower rates of mortality and morbidity. The small- and medium-volume centers have higher rates of major complications. When complications occurred the chance of rescue is higher in large-volume centers.
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Comparative Study
Differential outcomes with early and late repeat transplantation in the era of the lung allocation score.
Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era. ⋯ Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks.