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 2016
Impact of positional relationship of commissures on cusp function after valve-sparing root replacement for regurgitant bicuspid aortic valve.
The aim of this study is to investigate the longitudinal valve function after valve-sparing root replacement in patients with bicuspid aortic valves (BAVs), in terms of both transvalvular pressure gradient (TVPG) and freedom from aortic regurgitation. ⋯ In terms of freedom from aortic regurgitation and valve function, similar outcomes were achieved in both despite different repair techniques used for fixation of commissures during valve-sparing aortic root replacement in BAV. However, attention should be paid to patients with 180° commissural reposition because of a trend towards higher TVPG.
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Eur J Cardiothorac Surg · Jul 2016
Multicenter Study Comparative Study Clinical TrialIs a third arterial conduit necessary? Comparison of the radial artery and saphenous vein in patients receiving bilateral internal thoracic arteries for triple vessel coronary disease.
The use of bilateral internal thoracic arteries (BITAs) is associated with improved long-term survival after coronary artery bypass grafting (CABG). However, it is unclear whether the addition of a radial artery (RA) in patients already receiving BITA confers any additional survival benefit over that of a saphenous vein (SV). As such, we reviewed our multicentre experience and compared both strategies. ⋯ The addition of an RA graft even in patients already receiving BITAs is associated with a survival benefit. In younger patients with a reasonable long-term life expectancy, surgeons should strive to achieve total arterial revascularization with BITAs and radial arteries.
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Eur J Cardiothorac Surg · Jul 2016
Myocardial function after polarizing versus depolarizing cardiac arrest with blood cardioplegia in a porcine model of cardiopulmonary bypass.
Potassium-based depolarizing St Thomas' Hospital cardioplegic solution No 2 administered as intermittent, oxygenated blood is considered as a gold standard for myocardial protection during cardiac surgery. However, the alternative concept of polarizing arrest may have beneficial protective effects. We hypothesize that polarized arrest with esmolol/adenosine/magnesium (St Thomas' Hospital Polarizing cardioplegic solution) in cold, intermittent oxygenated blood offers comparable myocardial protection in a clinically relevant animal model. ⋯ Polarizing oxygenated blood cardioplegia with esmolol/adenosine/magnesium offers comparable myocardial protection and improves contractility compared with the standard potassium-based depolarizing blood cardioplegia.
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Eur J Cardiothorac Surg · Jul 2016
Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival.
To evaluate the feasibility of mitral valve repair in patients with anterior leaflet (ALP) or bileaflet prolapse (BLP) and identify factors predisposing patients to replacement. To compare long-term survival of patients submitted to repair (Group Repair) against those submitted to replacement (Group Replacement), and investigate causes of early and late failures of repair. ⋯ Patients with ALP or BLP can be submitted to surgery with low mortality and great probability of repair in expert hands. Patients should be operated on at an early phase (asymptomatic or mildly symptomatic), because there is a higher probability of repair and greater benefit on long-term survival.
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Eur J Cardiothorac Surg · Jul 2016
ReviewLung cancer screening: did we really need a randomized controlled trial?
Lung cancer is the leading cause of cancer mortality in the USA. Within the past decade, two large trials (the National Lung Screening Trial Research and the International Early Lung Cancer Action Program) confirmed a significant role for low-dose CT (LDCT) screening in identifying early stages of cancer leading to reduced mortality in high-risk patients. ⋯ Despite the strong support for LDCT among physicians who treat lung cancer and cumulative data demonstrating a survival benefit for screening and early detection, it took more than a decade for lung cancer screening to be embraced at the policy level. With many lives lost in the interim, did we really need a randomized controlled trial to make this decision?