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 2016
Review Meta AnalysisMeta-analysis of concomitant mitral valve repair and coronary artery bypass surgery versus isolated coronary artery bypass surgery in patients with moderate ischaemic mitral regurgitation.
Ischaemic mitral regurgitation (IMR) is a complication of coronary artery disease with normal chordal and leaflet morphology. Controversy surrounds the issue of appropriate surgical management of moderate IMR. With the present meta-analysis, we aimed to determine whether the addition of mitral valve (MV) repair to coronary artery bypass grafting (CABG) improved clinical outcome over CABG alone in patients with moderate IMR. ⋯ Risk of residual MR grade ≥2 was higher in the CABG only group [all studies: RR 0.30 (95% CI 0.16, 0.60), P < 0.001, I(2) = 83%; RCTs only: RR 0.20 (95% CI 0.04, 0.90), P = 0.04, I(2) = 72%]. There is neither increased operative mortality nor survival benefit associated with concomitant CABG and MV repair for IMR of moderate degree over CABG alone. Further studies with long-term follow-up data and sub-group analyses of current data are needed to define a subset of patients whose survival and functional status may improve with the concomitant MV repair.
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Eur J Cardiothorac Surg · Aug 2016
Thoracic endovascular aortic repair for degenerative distal arch aneurysm can be used as a standard procedure in high-risk patients.
In recent years, supra-aortic rerouting and thoracic endovascular aortic repair (TEVAR) for treating aortic arch pathology have emerged as a less invasive option for high-risk patients. This study aimed to assess our strategy for preventing stroke and improving late outcomes after supra-aortic rerouting and TEVAR. ⋯ Our strategy for supra-aortic rerouting and TEVAR showed satisfactory early and late results. The chief risk factor for perioperative stroke was atheroma, and blocking native forward flow from the LCA and the LSA prior to the TEVAR procedure helped prevent stroke.
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Eur J Cardiothorac Surg · Aug 2016
Long-term results of external aortic ring annuloplasty for aortic valve repair.
An untreated dilated aortic annulus is a major risk factor for failure of aortic valve-sparing operations or repair of either bicuspid or tricuspid valve. Aortic annuloplasty efficiently reduces the annulus and increases the coaptation height, thus protecting the repair. This study analyses long-term results of 232 consecutive patients operated on with a standardized and physiological approach to aortic valve repair according to each phenotype of the dystrophic ascending aorta. Subvalvular aortic annuloplasty was systematically added using an external aortic ring to reduce annulus diameter when ≥25 mm. ⋯ External aortic ring annuloplasty provides a reproducible technique for aortic valve repair with satisfactory long-term results for each ascending aorta phenotype with bicuspid or tricuspid valve. Longer follow-up is ongoing with the AVIATOR registry.
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Eur J Cardiothorac Surg · Aug 2016
Multicenter StudyOptimal timing of surgery for active infective endocarditis with cerebral complications: a Japanese multicentre study.
The aim of this study was to investigate the effect of the timing of valve surgery on the clinical outcomes of patients with active infective endocarditis (IE) accompanied by cerebral complications. ⋯ Although statistically insignificant, early surgery in active IE patients with CI is safe, but very early surgery (within 7 days) should be avoided in patients with ICH.
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Eur J Cardiothorac Surg · Aug 2016
Randomized Controlled TrialRandomized comparison of exercise haemodynamics of Freestyle, Magna Ease and Trifecta bioprostheses after aortic valve replacement for severe aortic stenosis.
The purpose of this study was to compare haemodynamics at rest and during exercise after clinically indicated aortic valve replacement (AVR) for aortic stenosis among patients randomly assigned to one of three haemodynamically excellent bioprostheses. ⋯ NCT01635244.