The Annals of thoracic surgery
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Comment Letter
Lobectomy versus limited resection in T1 N0 lung cancer.
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Randomized Controlled Trial Clinical Trial
Heparinized cardiopulmonary bypass and full heparin dose marginally improve clinical performance.
The use of completely heparin coated cardiopulmonary bypass circuits in combination with a reduced systemic heparin dose has previously been shown to reduce postoperative bleeding after cardiac operations. However, it has remained unknown whether this effect was related to the improved biocompatibility of the heparin-treated surfaces per se or to the reduced exposure to circulating heparin. Therefore we investigated patients undergoing heparin-coated extracorporeal circulation and full systemic heparinization. ⋯ The use of completely heparin coated cardiopulmonary bypass circuits and full systemic heparinization in patients undergoing coronary artery bypass procedures did not reduce postoperative bleeding or change clinical performance, except for a significant decrease in the incidence of postoperative atrial fibrillation.
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Composite aortic root replacement is accepted treatment for aneurysms of the ascending aorta involving the root with aortic valve regurgitation, but controversy continues regarding the best technique of operation. We excise the aneurysm, implant a composite valve graft, directly attach the coronary arteries to the aortic graft, and make the distal anastomosis to the divided aorta. ⋯ Composite aortic root replacement with direct coronary implantation is effective and durable treatment for a variety of aortic pathologic conditions in elective and emergency situations.
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Comparative Study
Comparison of techniques for implantation of aortic valve allografts.
Various implantation techniques for allograft aortic valve replacement have evolved over the years. Our objective was to examine the effects of different implantation methods on subsequent valve performance and durability. ⋯ The insertion of an aortic valve allograft as a cylinder, retaining the sinotubular junction, appears to result in less aortic regurgitation at 7 years postoperatively, and with additional follow-up may result in less reoperation for AR.
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Residual left ventricular hypertrophy adversely affects long-term outcome after aortic valve replacement. A stentless biological valve in the aortic position has been shown to offer a better hemodynamic profile than a stented one. However, it remains to be defined whether this difference is translated into inter-mediate-term effects on left ventricular structure and function. ⋯ In the first 2 years after implantation, the superior hemodynamic performance of aortic homograft and stentless porcine valve appears to result in more extensive regression of ventricular hypertrophy and greater improvement of left ventricular function than occurs with a mechanical or stented biological valve. These findings encourage the use of a stentless biological valve in older patients requiring aortic valve replacement, and a larger scale long-term randomized study of stentless versus stented biological valve or mechanical valve seems warranted.