European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2007
Is size-reducing ascending aortoplasty with external reinforcement an option in modern aortic surgery?
Enlargement of the ascending aorta is often combined with valvular, coronary, or other cardiac diseases. Reduction aortoplasty can be an optional therapy; however, indications regarding the diameter of aorta, the history of dilatation (poststenosis, bicuspid aortic valve), or the intraoperative management (wall excision, reduction suture, external reinforcement) are not established. ⋯ As demonstrated in this study, size reduction of the ascending aorta using aortoplasty with external reinforcement is a safe procedure with excellent long-term results. It is a therapeutic option in modern aortic surgery in patients with poststenotic dilatation of the aorta without impairment of the sinotubular junction of the aortic valve and root.
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Eur J Cardiothorac Surg · Apr 2007
Aortic valve surgery in octogenarians: predictive factors for operative and long-term results.
To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). ⋯ AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent.
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Eur J Cardiothorac Surg · Apr 2007
Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia.
Although antegrade selective cerebral perfusion (ASCP) has been demonstrated to be the best method of protection of brain ischemia during aortic arch surgery, there is no consensus regarding optimal temperature during ASCP. The study analyzed the outcomes of aortic surgery using ASCP at different degree of systemic hypothermia. ⋯ In our experience, ASCP was a safe technique for thoracic aorta surgery allowing complex aortic repairs to be performed with good results in terms of hospital mortality and neurologic outcomes. The fact that there was no difference between the two groups suggests that moderate systemic hypothermia (26 degrees C) appears to be a safe and sufficient tool for brain protection. Moreover, the well known hypothermia-related side effects may be avoided.
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Eur J Cardiothorac Surg · Apr 2007
Spinal cord perfusion after extensive segmental artery sacrifice: can paraplegia be prevented?
Understanding the ability of the paraspinal anastomotic network to provide adequate spinal cord perfusion pressure (SCPP) critical for both surgical and endovascular repair of thoracoabdominal aortic aneurysms (TAAA). ⋯ Interruption of all SAs at 32 degrees C in this pig model results in a spectrum of cord injury, with normal function in a majority of pigs postoperatively. The short duration of low SCPP suggests that hemodynamic manipulation lasting only 24-48h may allow routine complete preservation of normal cord function despite sacrifice of all SAs.