European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Dec 2011
Implications of acute kidney injury after heart transplantation: what a surgeon should know.
Data regarding risks and consequences of acute kidney injury (AKI) after cardiac transplantation are dismissingly few and unclear. This study defined the incidence, risk factors and prognostic implication of AKI in a single-center cohort operated on between January 1999 and December 2008. ⋯ AKI is a highly prevalent and prognostically important complication. Some of the risk factors for AKI identified may be modifiable.
-
Eur J Cardiothorac Surg · Nov 2011
Meta AnalysisAortic valve replacement for aortic stenosis in patients with concomitant mitral regurgitation: should the mitral valve be dealt with?
Co-existent mitral regurgitation may adversely influence both morbidity and mortality in patients undergoing aortic valve replacement for severe aortic stenosis. Whilst it is accepted that concomitant mitral intervention is required in severe, symptomatic mitral regurgitation, in cases of mild-moderate non-structural mitral regurgitation, improvement may be seen following aortic valve replacement alone, avoiding the increased risk of double-valve surgery. The exact benefit of such a conservative approach is, however, yet to be adequately quantified. ⋯ No significant change was seen in left-ventricular end-systolic diameter (p=0.10), septal thickness (p=0.17) or left atrial area (p=0.23). We conclude that despite reverse remodelling, concomitant moderate-severe mitral regurgitation adversely affects both early and late mortality following aortic valve replacement. Concomitant mitral intervention should therefore be considered in the presence of moderate mitral regurgitation, independent of the aetiology.
-
Eur J Cardiothorac Surg · Nov 2011
Trans-catheter valve-in-valve implantation: in vitro hydrodynamic performance of the SAPIEN+cloth trans-catheter heart valve in the Carpentier-Edwards Perimount valves.
Since 1990, over 1.2 million bioprosthetic valves were implanted for aortic stenosis. Given the risk of structural valve deterioration, the need to redo AVR will likely rise. Recently, SAPIEN valve-in-valve (ViV) has been advocated. We evaluated the in vitro hydrodynamic performance of the Edwards SAPIEN+cloth trans-catheter heart valve (THV) implanted within the Carpentier-Edwards Perimount (CEP) valve. ⋯ Compared with the rigorous ISO 5840:2500 valve standards, the Edwards SAPIEN+cloth THV implanted ViV within the CEP valve demonstrated excellent hydrodynamic performance.
-
Eur J Cardiothorac Surg · Nov 2011
Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection.
The aimed to describe the frozen elephant trunk (FET) technique and partial remodeling (PR) for acute type A aortic dissection (ATAAD), considering the long-term prognosis on the basis of our 13 years of experience. ⋯ FET and modified PR techniques could be effective for improving the long-term outcome on the distal and proximal aorta in an ATAAD.
-
Eur J Cardiothorac Surg · Nov 2011
The importance of blood lactate clearance as a predictor of early mortality following the modified Norwood procedure.
Optimisation of Norwood physiology, with focus on systemic perfusion, has beneficial effects on haemodynamic stability and perioperative mortality following the Norwood procedure for hypoplastic left heart syndrome. Early identification of high-risk patients during the postoperative phase might allow for institution of alternative management strategies with the possibility of avoiding poor outcome. Several studies have suggested that arterial blood lactate level, as an index of systemic perfusion and oxygen delivery, can to some extent predict mortality following paediatric cardiac surgery, though these studies have included heterogeneous groups of patients with only few Norwood patients. We sought to determine whether the blood lactate profile could be used to derive a simple, clinically applicable decision algorithm to direct therapy in a pre-emptive manner and perhaps identify patients for elective extracorporeal life support following the Norwood procedure. ⋯ We have identified minimum blood lactate level within the first 24h after the Sano-Norwood procedure as a highly discriminatory predictor of perioperative mortality. These patients might benefit from elective institution of early mechanical circulatory support.