European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2012
Cardiac reoperations following the Ross procedure in children: spectrum of surgery and reoperation results.
The Ross procedure is the preferred aortic valve replacement (AVR) choice in small children. Nonetheless, it is a complicated surgery and there are concerns that subsequent cardiac reoperations are exceptionally complex and associated with high morbidity and mortality. We examine the surgical spectrum and report outcomes of cardiac reoperations in patients who had undergone the Ross procedure during childhood. ⋯ A wide range of cardiac reoperations may be required in children following the Ross procedure, especially those with underlying rheumatic aetiology, aortic regurgitation and multivalvular involvement. Despite complexity, reoperation following the Ross procedure can be performed with low mortality and good mid-term results. This information should be taken into consideration during the selection of aortic valve substitute in children.
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Eur J Cardiothorac Surg · Jul 2012
Comparative Study Clinical TrialMortality and neurodevelopmental outcome at 1 year of age comparing hybrid and Norwood procedures.
Neonates with hypoplastic left heart syndrome (HLHS) are at risk of high mortality and neurodevelopmental morbidity. As an alternative to Norwood-type stage I palliation, the hybrid procedure has been developed. It consists of bilateral pulmonary artery banding, catheter-based stenting of the arterial duct and balloon atrioseptostomy and delays open-heart surgery. Thus, it may be associated with a better outcome. The aim of this study was to determine the mortality and neurodevelopmental outcome in patients with HLHS and other univentricular heart (UVH) defects treated with hybrid or Norwood procedures. ⋯ Mortality at 1 year of age is comparable between patients undergoing hybrid and Norwood procedures. Early neurodevelopmental outcome is significantly impaired in patients with both HLHS and other UVH defects. Multicentre randomized studies are needed to determine the long-term neurodevelopmental outcome of children treated with the hybrid procedure.
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Eur J Cardiothorac Surg · Jul 2012
Mid-term results of bioprosthetic pulmonary valve replacement in pulmonary regurgitation after tetralogy of Fallot repair.
Pulmonary valve replacement (PVR) is performed to reduce right ventricular (RV) volume overload, resulting in improved ventricular function and clinical status. Significant pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair could result in RV dysfunction, exercise intolerance, arrhythmia and sudden death. The present study was conducted to investigate the mid-term clinical outcomes of PVR after TOF repair. ⋯ PVR reduced the RV volume and improved the RV function within the first postoperative year. The rate of freedom from reoperation during the 10-year follow-up period in our series was acceptable. However, a longer follow-up will be necessary to determine the long-term outcomes of bioprosthetic valves in PVR.
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Eur J Cardiothorac Surg · Jul 2012
Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation.
The Glenn bidirectional cavopulmonary connection (BCPC) is an established procedure in multistage palliation of various single ventricle (SV) anomalies. We aimed to report the current outcomes following BCPC and to examine risk factors affecting survival and progression to the next palliation stage. ⋯ Despite established selection criteria and improved surgical technique and medical management, there is a continuous failure and attrition risk following BCPC. Outcomes are influenced by underlying cardiac anomaly; patients with dominant left ventricle (i.e. tricuspid atresia, double inlet left ventricle) having the best survival while those with dominant right ventricle (i.e. hypoplastic left heart syndrome, double outlet right ventricle with heterotaxy) having the worst survival. Increased PVR remains a significant factor affecting mortality.
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Eur J Cardiothorac Surg · Jul 2012
Transfusion of blood during cardiac surgery is associated with higher long-term mortality in low-risk patients.
Numerous reports have emphasized the need for reduction in transfusions of allogeneic red blood cells (RBC) due to increased morbidity and mortality. Nevertheless, transfusion rates are still high in several cardiac surgery institutions. Reports on long-term survival after cardiac surgery and RBC transfusion are few. ⋯ Long-term follow-up of low-risk patients undergoing simple cardiac surgery demonstrates a more than 10% higher mortality when receiving perioperative RBC transfusion. Even transfusion of 1-2 units seems to carry a risk of that magnitude.