The Annals of thoracic surgery
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Changes in memory and cognition frequently follow cardiac operations. We hypothesized that patients with the apolipoprotein E-epsilon 4 allele are genetically predisposed to cognitive dysfunction after cardiac operations. ⋯ This study suggests that apolipoprotein E genotype is related to cognitive dysfunction after cardiopulmonary bypass. Cardiac surgical patients may be susceptible to deterioration after physiologic stress as a result of impaired genetically determined neuronal mechanisms of maintenance and repair.
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The mechanism by which cardiomyoplasty appears to enhance left ventricular (LV) function is not well understood. We applied the time-varying elastance model to study the effect of cardiomyoplasty on LV function, ventriculovascular coupling, and LV energetics in an acute canine model. ⋯ These results support the theory that cardiomyoplasty unloads the LV by decreasing LV volumes and increasing contractility. These effects appear to improve LV energetics by decreasing total mechanical work without significantly affecting stroke work, resulting in improved stroke work efficiency. The decrease in total mechanical work strongly suggests a decrease in myocardial oxygen consumption and an increase in overall mechanical efficiency.
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Comparative Study
Impact of previous thoracic aneurysm repair on thoracoabdominal aortic aneurysm management.
The purpose of this study was to determine the impact of previous thoracic aortic aneurysm repair (PTAR) on subsequent thoracoabdominal aortic aneurysm operations. ⋯ The presence of a PTAR did not adversely affect the outcome of thoracoabdominal aortic aneurysm repair. After thoracic aortic aneurysm repair, life-long radiologic surveillance and early surgical treatment are justified.
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Comparative Study
Previous coronary artery bypass grafting is not a risk factor for aortic valve replacement.
The risk of aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG) is controversial. Its magnitude influences the threshold for recommending this procedure and has been cited in arguments regarding the optimal management of mild aortic stenosis at primary CABG. We therefore reviewed our experience with reoperative AVR +/- CABG and the primary combined procedure. ⋯ The risk of AVR after previous CABG is similar to that for primary AVR+CABG. Valve replacement should, therefore, be pursued despite prior CABG when hemodynamically significant aortic stenosis develops. Furthermore, a circumspect approach to "prophylactic" AVR for mild aortic stenosis at primary CABG seems warranted.