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 2013
Management of moderate secondary mitral regurgitation at the time of aortic valve surgery.
To define the impact of surgical strategy [concomitant mitral valve surgery or isolated aortic valve replacement (AVR)] in patients with moderate secondary mitral regurgitation (MR) at the time of AVR. ⋯ Secondary MR improves after AVR even without mitral surgery. Concomitant mitral surgery was significantly associated with greater improvement of postoperative MR, but had no significant impact on survival. However, patients who did not improve immediately after AVR had compromised survival. Patients in AF should have mitral valve repair at the time of surgery.
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Eur J Cardiothorac Surg · Jul 2013
Late complications and distal growth rates of Marfan aortas after proximal aortic repair.
Conflicting results have been reported on late aortic growth and complication rates of the descending thoracic aorta in patients with Marfan syndrome (MFS) after proximal aortic surgery. ⋯ Late distal complication rates are low for patients initially presenting with aneurysms. The risk of late distal reoperation is dictated by the initial pathology and by the presence of an initial dissection and not by faster distal aortic growth. Strategies to completely restore a non-dissected anatomy might improve late surgical outcome in Marfan's syndrome.
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Eur J Cardiothorac Surg · Jul 2013
Transapical transcatheter aortic valve implantation vs conventional aortic valve replacement in high-risk patients with previous cardiac surgery: a propensity-score analysis.
The present analysis compared clinical and mid-term outcomes of patients with previous cardiac surgery undergoing transapical transcatheter aortic valve implantation (TAVI) with propensity-matched patients undergoing conventional redo aortic valve replacement (cAVR). ⋯ Transapical TAVI as well as surgical aortic valve replacement provided good clinical results. The pattern of postoperative morbidity and mortality was different for both entities, but the final clinical outcome did not differ significantly. Both techniques can be seen as complementary approaches by means of developing a tailor-made and patient-orientated surgery.
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Eur J Cardiothorac Surg · Jul 2013
Mitral valve repair and bioprosthetic replacement without postoperative anticoagulation does not increase the risk of stroke or mortality.
The study aimed to determine if mitral valve repair (MVRR) or bioprosthetic mitral valve replacement (BMVR) without postoperative anticoagulation is associated with a similar risk of thromboembolism and death as anticoagulation. ⋯ Despite current guidelines recommending postoperative anticoagulation following MVRR or bioprosthetic replacement, the avoidance of warfarin does not increase perioperative complications and has no impact on intermediate survival. Accordingly, a prospective randomized study to adjudicate the role of extended warfarin thromboprophylaxis in mitral valve surgery is warranted.
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Eur J Cardiothorac Surg · Jul 2013
Short-term experience of porcine small intestinal submucosa patches in paediatric cardiovascular surgery.
Surgical reconstructions or palliations of congenital heart defects often require the utilization of patches, of which the ideal material has yet to be discovered. Recently, porcine small intestinal submucosa extracellular matrix (SIS-ECM) has been advocated as an alternative to conventional synthetic or biological patch material. Here, we present our initial experience with SIS-ECM in paediatric cardiovascular reconstructions. ⋯ SIS-ECM is suitable for the closure of septal defects. Use of SIS-ECM for the reconstructions of outflow tracts and great vessels carries a small risk of stenosis, especially in patches that form the majority of the vessel circumference. The long-term follow-up is needed to determine the risk of late stenosis.