European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2013
Comparative Study Clinical TrialSurgical treatment of left main disease and severe carotid stenosis: does the off-pump technique provide a better outcome?
Left main disease (LMD), combined with carotid artery stenosis (CAS), constitutes a high-risk patient population. Priority is often given to coronary revascularization, due to the severity of the angina. However, the choice of revascularization strategy [off-pump coronary artery bypass (OPCAB) vs coronary artery bypass grafting (CABG)] remains elusive. ⋯ Off-pump coronary revascularization may offer risk reduction of neurological complications in patients with a significant carotid artery disease and a history of previous stroke, but a larger study population is needed to support this thesis. The growing discrepancy in long-term survival should draw attention to a more complete revascularization in OPCAB patients.
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Eur J Cardiothorac Surg · Mar 2013
Impact of the maze procedure and postoperative atrial fibrillation on progression of functional tricuspid regurgitation in patients undergoing degenerative mitral repair.
The aim of this study is to investigate the factors contributing to the progression of functional tricuspid regurgitation (TR) after mitral repair for degenerative mitral regurgitation (MR) in relation to pre and postoperative atrial fibrillation (AF) and performance of the maze procedure. ⋯ Preoperative AF without the maze procedure and postoperative AF can contribute to the development of moderate or greater functional TR after mitral repair for degenerative MR.
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Eur J Cardiothorac Surg · Mar 2013
Is heart transplantation for complex congenital heart disease a good option? A 25-year single centre experience.
Heart transplantation (HTx) in patients with complex congenital heart disease (CHD) is a challenge because of structural anomalies and multiple previous procedures. We analysed our results in adult and paediatric patients to evaluate outcome and assess risk factors affecting mortality. ⋯ We demonstrated that heart transplantation for patients with CHD can be performed with the expectation of excellent results. Previous procedures, including the Fontan operation, do not reduce survival. Mortality is related to preoperative patient condition. We advocate early referral of complex CHD patients for transplant assessment and for inclusion in waiting lists before the detrimental effects of end-stage failure manifest themselves.
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Eur J Cardiothorac Surg · Mar 2013
Early and late prognostic implications of coronary artery bypass timing after myocardial infarction.
The optimal timing of coronary artery bypass grafting (CABG) after myocardial infarction (MI) is still controversial. With advances in perioperative care and myocardial protection, CABG is not infrequently undertaken sooner. Although CABG soon after MI is associated with high morbidity and mortality, the impact of CABG timing on late survival is not clear. ⋯ Early and late mortality risk for CABG declines with increasing interval from MI for reasons indirectly linked to the timing of surgery. Our findings emphasize the importance of preoperative organ system optimization and consistent left internal mammary artery use, regardless of the proximity of surgery to MI or the exigency of surgery.