European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Sep 2009
Sustained improvement after combined anterior mitral valve leaflet retention plasty and septal myectomy in preventing systolic anterior motion in hypertrophic obstructive cardiomyopathy in children.
Anatomic alterations of the mitral valve such as increased mitral leaflet area, length and laxity, and anterior displacement of the papillary muscles in hypertrophic obstructive cardiomyopathy predispose patients to residual systolic anterior motion and persistence of outflow obstruction and mitral regurgitation after septal myectomy. We investigate the long-term results of combined anterior mitral leaflet retention plasty and septal myectomy in children with hypertrophic obstructive cardiomyopathy. ⋯ Long-term follow-up shows sustained absence of systolic anterior motion, attenuation of mitral regurgitation, sustained improvement in functional status, and reduction of outflow tract obstruction.
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Eur J Cardiothorac Surg · Sep 2009
The impact of the lung allocation scoring system at the single national Veterans Affairs Hospital lung transplantation program.
The lung allocation score (LAS) has changed the distribution of donor lungs for transplantation. This study was undertaken to evaluate the impact of the LAS on a unique patient population undergoing lung transplantation (LTX) at the single national Veterans Affairs (VA) LT center. ⋯ The LAS appears to be achieving its objectives by reducing waitlist time and altering the distribution of lung disease being transplanted on the basis of medical necessity in the U.S. VA population. In addition, the LAS does not appear to have adversely affected short-term post-transplant outcomes in our recipient cohort.
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Eur J Cardiothorac Surg · Sep 2009
Comparative StudyVideo-assisted versus open pulmonary metastasectomy: the surgeon's finger or the radiologist's eye?
The use of VATS metastasectomy remains controversial because of doubt surrounding its ability to remove palpable but CT occult lesions. We aim to evaluate our policy of elective VATS and compare it with our results with open metastasectomy. ⋯ The selective use of VATS therapeutic metastasectomy in conjunction with multi-detector CT is justified in metastatic colorectal adenocarcinoma. The insertion of the surgical digit is not mandatory. Trust the radiologist's eye.
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Eur J Cardiothorac Surg · Sep 2009
Valve-sparing aortic root remodeling with partial preservation of the intact native aortic sinuses.
There are certain aortic root pathologies where only one or two of the aortic sinuses are diseased. We aimed to evaluate our mid-term results after a partial remodeling of the aortic root. A total of 220 patients underwent a valve-sparing operation at our institution. ⋯ Longitudinal analysis revealed no development of clinically significant aortic regurgitation (<0.03 grades per year). However, in contrast to the group that underwent complete remodeling (n=108), a significant dilatation at sinus and ST junction (STJ) level could be observed in the partial remodeling group over time (0.35 and 0.48 mm per year, respectively). This should be taken into consideration when applying this technique in patients operated on an elective basis.
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Eur J Cardiothorac Surg · Sep 2009
Brain preservation with selective cerebral perfusion for operations requiring circulatory arrest: protection at 25 degrees C is similar to 18 degrees C with shorter operating times.
Hypothermic circulatory arrest (HCA) is employed for aortic arch and other complex operations, often with selective cerebral perfusion (SCP). Our previous work has demonstrated real-time evidence of improved brain protection using SCP at 18 degrees C. The purpose of this study was to evaluate the utility of SCP at warmer temperatures (25 degrees C) and its impact on operating times. ⋯ HCA results in cerebral hypoxia, energy depletion and ischaemic injury, which are attenuated with the use of SCP at both 18 degrees C and 25 degrees C. Procedures performed at 25 degrees C had significantly shorter operating times while preserving end organs.