European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Nov 2012
Review Meta AnalysisEfficacy of tranexamic acid in paediatric cardiac surgery: a systematic review and meta-analysis.
The benefit-to-risk ratio of using tranexamic acid (TXA) in paediatric cardiac surgery has not yet been determined. This systematic review evaluated studies that compared TXA to placebo in children undergoing cardiac surgery. A systematic search was conducted in all relevant randomized controlled trials. ⋯ There was marked variability in the dosage and infusion schemes used in different studies. This systematic review showed that in paediatric cardiac surgery, the benefit-to-risk ratio associated with the use of TXA cannot be adequately defined. Evidence supporting the routine use of TXA in paediatric cardiac surgery remains weak.
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Eur J Cardiothorac Surg · Nov 2012
Practice GuidelineUpdated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2).
The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. ⋯ This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavours of applying definitions to other transcatheter valve therapies (for example, mitral valve repair).
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Eur J Cardiothorac Surg · Nov 2012
How to achieve an aortic root remodelling by performing an aortic root reimplantation.
The aortic root remodelling procedure, introduced by Yacoub in the early 1980s, is the valve-sparing aortic root replacement procedure that better reproduces the anatomical and functional properties of the native aortic root. Long-term durability of the repair, in terms of freedom from recurrent aortic regurgitation, has been questioned and can probably be improved by appropriate patient selection. Reproducibility of the operation, however, depends on subjective evaluations and surgical skill. We report a simplification of the technique designed to possibly increase the reproducibility of the aortic root remodelling operation while retaining its functional advantages.
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Eur J Cardiothorac Surg · Nov 2012
Comparative StudyThe effect of morphologic subtype on outcomes following the Sano-Norwood procedure.
Controversy exists concerning outcomes of patients with different morphologic subtypes of hypoplastic left heart syndrome undergoing the Norwood procedure, in particular, aortic atresia-mitral stenosis (AA-MS) patients receiving a systemic-pulmonary modified Blalock-Taussig (mBT) shunt. We sought to determine the influence of known risk factors and morphology on early survival in our cohort of Sano-Norwood patients with right ventricle-pulmonary artery (RV-PA) conduits as the source of pulmonary blood flow. ⋯ Use of the RV-PA conduit results in good early survival, even in those with a small AscAo size. Atypical morphologic variants seem to do worse irrespective of the Sano or mBTS group. Further studies will be required to determine conclusively whether the RV-PA shunt confers protective effects in the AA-MS subgroup compared with the mBTS.
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Eur J Cardiothorac Surg · Nov 2012
Descending aortic aneurysmal changes following surgery for acute DeBakey type I aortic dissection.
The aim of the study was to determine the risk factors for descending aortic aneurysmal changes following surgery for acute DeBakey type I aortic dissection. ⋯ The proximal descending aorta was the major site of aneurysm formation following surgery for acute type I aortic dissection. The large proximal descending aortic diameter on initial CT predicted the late aneurysm, suggesting that adjunctive procedures combined with aortic replacement are needed to prevent the late aneurysm.