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
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.
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Eur J Cardiothorac Surg · Sep 2013
Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach.
Transcatheter aortic valve implantation (TAVI) has emerged rapidly. Despite unanimous recommendations and potentially fatal intraoperative complications, the heart-team approach is not comprehensively adopted by all centres. We sought to characterize severe intraprocedural complications during TAVI requiring immediate surgical or interventional bailout manoeuvres and evaluate outcomes. ⋯ An interdisciplinary approach to TAVI facilitated bailout procedures accomplishing acceptable outcomes, despite severe intraprocedural complications. These bailout manoeuvres in potentially fatal complications were only accomplished through an interdisciplinary heart-team effort, creating a surgical and interventional safety net, which should be established in all centres performing TAVI procedures.
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Eur J Cardiothorac Surg · Sep 2013
Surgical or percutaneous mitral valve repair for secondary mitral regurgitation: comparison of patient characteristics and clinical outcomes.
Corrective surgery for secondary mitral regurgitation (MR) by restrictive annuloplasty has proven beneficial in that it improves New York Heart Association (NYHA) functional class and induces reverse left ventricular remodelling. However, proof of a survival benefit for these patients is still pending. Percutaneous techniques of mitral valve repair (MVR) have become a viable treatment alternative for selected high-risk patients with severe secondary MR. ⋯ In our experience, characteristics and risk factors of patients with severe secondary MR undergoing surgery differ significantly from those considered for percutaneous therapy. Surgery was more effective compared with MitraClip in reducing MR. However, a large proportion of patients benefits from percutaneous intervention with sustained MR Grade <2+ and improvement in NYHA functional class at 6 months. MitraClip therapy seems to be an adequate alternative to surgery, especially for elderly patients with reduced left ventricular function and relevant comorbidities. Assessment, treatment and postprocedural care of patients by an interdisciplinary team are of paramount importance for clinical success.