European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2007
Long-term follow-up after mitral valve replacement in childhood: poor event-free survival in the young child.
In children, mechanical mitral valve replacement may be the only option if the failing mitral valve cannot be repaired. Mandatory anticoagulation and the fixed size prosthesis are of concern in the growing child, but long-term follow-up results are lacking. ⋯ At 10 years follow-up after mechanical mitral valve replacement, most children had suffered an adverse event. At 15 years, all children with a prosthesis<23 mm had outgrown their valve, but redo-mitral valve replacement with a larger size prosthesis was always possible, and carried low operative risk. Long-term anticoagulation was well tolerated. In children every effort should be made to preserve the native valve.
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Eur J Cardiothorac Surg · May 2007
Replacing the diseased aortic valve and the proximal aorta in the elderly patient.
Subcoronary implantation of the Medtronic stentless bioprosthesis and an extension using a vascular tube prosthesis provide a safer alternative to the more invasive conventional composite graft replacement or a full root replacement using a homograft or a stentless valve. The advantage lies in eliminating the need for coronary mobilisation and anastomosis which actually lead to the increased risk in those procedures.
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Eur J Cardiothorac Surg · May 2007
Late coronary artery lesions after neonatal arterial switch operation: results of surgical coronary revascularization.
To evaluate the results of surgical revascularization in children with coronary artery lesions following neonatal arterial switch operation (ASO). ⋯ (1) Following ASO, coronary lesions are not uncommon and they are progressive. Routine and sequential coronary evaluation is necessary. (2) Coronary revascularization can be achieved using coronary angioplasty in most cases. Mammary bypass may be used in selected circumstances. Normal myocardial perfusion is restored in most patients.
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Eur J Cardiothorac Surg · May 2007
Randomized Controlled TrialEffect of preoperative angiotensin converting enzyme inhibitor or angiotensin receptor blocker use on the frequency of atrial fibrillation after cardiac surgery: a cohort study from the atrial fibrillation suppression trials II and III.
Two recent meta-analyses demonstrated that angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the risk of developing new-onset atrial fibrillation (AF) by nearly 50%. However, the ability of ACEIs or ARBs to prevent postoperative atrial fibrillation (POAF) after cardiac surgery has not been adequately evaluated. ⋯ Although preoperative ACEI or ARB use reduced the odds of developing POAF by 29%, this association with not found to be statistically significant. A study with approximately 600 subjects would be needed to discern if ACEIs or ARBs truly impact POAF.
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Eur J Cardiothorac Surg · May 2007
Comparative StudyAllografts for aortic valve or root replacement: insights from an 18-year single-center prospective follow-up study.
Whether allografts are the biological valve of choice for AVR in non-elderly patients remains a topic of debate. In this light we analyzed our ongoing prospective allograft AVR cohort and compared allograft durability with other biological aortic valve substitutes. ⋯ The use of allografts for AVR is associated with low occurrence rates of most valve-related events, but over time the risk of SVD increases, comparable to stented xenografts. It remains in our institute the preferred valve substitute only for patients with active aortic root endocarditis and for patients in whom anticoagulation should be avoided.