European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2013
Multicenter StudyOff-pump surgery in preventing perioperative stroke after coronary artery bypass grafting: a retrospective multicentre study.
To determine the effect of the off-pump technique in preventing stroke development during the early perioperative period after coronary artery bypass graft surgery (CABG). ⋯ Off-pump surgery has a lower perioperative stroke incidence than on-pump only in cases associated with cardiovascular stroke-risk factors, in particular, with chronic renal failure and preoperative cardiac failure, but also with peripheral arteriopathy, prior stroke and non-elective surgery. The perioperative stroke rate remains high in cases with two or more preoperative stroke risk factors, even when using the off-pump technique, particularly when chronic renal failure is present.
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Eur J Cardiothorac Surg · Oct 2013
Propensity-matched analysis of bilateral internal mammary artery vs single internal mammary artery in 7702 cases of isolated coronary artery bypass grafting.
To evaluate early outcomes of bilateral internal mammary artery (BIMA) compared with single IMA (SIMA) in patients who underwent isolated coronary artery bypass grafting (CABG). ⋯ The use of BIMA did not affect either short-term survival as postoperative mortality was low in both groups, or overall morbidity despite higher incidence of deep sternal infection.
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Type IIIa mitral regurgitation (MR) due to rheumatic leaflet restriction often renders valve repair challenging and may predict a less successful repair. However, the utilization of leaflet mobilization and extension with the pericardium to increase the surface of coaptation may achieve satisfactory results. We reviewed our experience with leaflet extension in rheumatic mitral repair with emphasis on the technique and mid-term results. ⋯ Repair with leaflet extension in rheumatic disease resulted in good early and mid-term outcomes. A wider utilization of this technique may increase the feasibility and durability of repair in complex rheumatic mitral valve disease.
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Eur J Cardiothorac Surg · Oct 2013
Comparative StudyRevascularization in left main coronary artery disease: comparison of off-pump coronary artery bypass grafting vs percutaneous coronary intervention.
There is no evidence for the increasing use of percutaneous coronary intervention (PCI) compared with surgery in patients with left main coronary artery (LMCA) disease. We compared the clinical outcomes of patients with LMCA disease who had undergone PCI with those of patients who had off-pump coronary artery bypass (OPCAB) grafting. ⋯ Compared with PCI, OPCAB is associated with a lower incidence of MACCE in patients with LMCA disease, determined mainly by the lower incidences of acute myocardial infarction and target-vessel revascularization. The incidence of stroke in the OPCAB group was similar to the PCI group.
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Eur J Cardiothorac Surg · Oct 2013
The transaortic approach for transcatheter aortic valve implantation: a valid alternative to the transapical access in patients with no peripheral vascular option. A single center experience.
Transcatheter aortic valve implantation (TAVI) in patients with poor peripheral vessels still remains problematic, as the transapical approach is not always feasible and is sometimes associated with myocardial damage, bleeding, post-procedural chest pain and pleural effusion. In order to address these issues, we adopted the recently introduced transaortic (TAo) approach. The purpose of this study was to evaluate the efficacy and safety of the TAo-TAVI approach using both the Sapien XT and the CoreValve according to VARC criteria. ⋯ The TAo approach for both Sapien XT and CoreValve implantation can be used with satisfactory clinical outcome and an acceptable risk. This access route could prove a valid alternative to the transapical approach.