European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2014
Pathological analysis of the aortic valve after long-term left ventricular assist device support.
Aortic insufficiency (AI) often develops during left ventricular assist device (LVAD) support and is related to a poor prognosis. As LVAD implantation and the support duration increase, the risk of acquired aortic valve lesions may increase. We investigated the pathological changes in the aortic valve and its function after long-term LVAD support. ⋯ Degenerative aortic valve changes were recognized after long-term LVAD support. There was also an increasing prevalence of mild and mild-to-moderate AI, which may have been associated with continuous aortic valve closure. An optimal strategy to prevent AI development should be determined, and careful periodic echocardiographic follow-up is essential.
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Eur J Cardiothorac Surg · Aug 2014
Extracorporeal life support for cardiogenic shock: influence of concomitant intra-aortic balloon counterpulsation.
Intra-aortic balloon counterpulsation (IABP) during extracorporeal life support (ECLS) for cardiogenic shock may improve pulsatility and coronary perfusion, thereby promoting recovery of cardiac function. However, the risks and benefits of IABP during ECLS in real clinical settings have not been evaluated. This study aims to evaluate the effect of IABP on the early outcome of ECLS for cardiogenic shock. ⋯ The use of IABP during ECLS increased a successful ECLS weaning rate, but was not translated into improved survival. Studies on larger populations may verify the survival effect of IABP during ECLS.
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Eur J Cardiothorac Surg · Aug 2014
Endovascular therapy in patients with genetically triggered thoracic aortic disease: applications and short- and mid-term outcomes.
For patients with genetically triggered thoracic aortic disease, the morbidity and mortality associated with reoperation are high, making endovascular treatment an appealing option. We evaluated the short- and mid-term outcomes of different applications of endovascular intervention in such patients. ⋯ Endovascular technology can be helpful in treating selected young patients with genetically triggered thoracic aortic disease. Long-term studies and further evolution of endovascular technology will be necessary for it to be incorporated into the armamentarium of surgical options for this challenging patient population.
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Eur J Cardiothorac Surg · Aug 2014
Should males ever undergo wedge resection for stage 1 non-small-cell lung cancer? A propensity analysis.
Wedge resections are frequently performed for small peripheral lesions in patients unfit for a more extensive resection. We aimed to investigate whether patient sex and histology type are important factors determining survival in patients undergoing a wedge resection for stage I lung cancer. ⋯ Long-term survival of patients with stage I non-small-cell lung cancer who undergo a wedge resection is affected by gender and histological type. Male patients undergoing wedge resections for adenocarcinoma have outcomes inferior to those of patients with squamous carcinoma. Histology type does not affect survival in female patients undergoing wedge resections.
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Eur J Cardiothorac Surg · Aug 2014
Ministernotomy versus conventional sternotomy for aortic valve replacement: matched propensity score analysis of 808 patients.
The proportion of minimally invasive approaches is rising in cardiac surgery, in part driven by increasing patient demand. This study aimed to perform a risk-adjusted comparison of mortality, rate of stroke and perioperative morbidity of aortic valve replacement (AVR) conducted through either partial mini-sternotomy or conventional sternotomy. ⋯ AVR can be safely conducted through a partial mini-sternotomy. This approach is not associated with an increased rate of complications. However, wide CIs reflect the still prevailing statistical uncertainty in estimates, not excluding patient-relevant differences between approaches. Large trials, which also address end points, such as postoperative pain, duration of postoperative recovery and quality of life, are needed to clarify the role of minimally invasive AVR.