Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Comparative StudyThe Clinical Significance of Cerebral Microbleeds in Infective Endocarditis Patients.
We assessed the clinical features of cerebral microbleeds (CMBs) and their association with clinical outcomes in active infective endocarditis patients. From January 2009 to June 2015, 132 active IE patients diagnosed per the modified Duke's criteria were retrospectively reviewed. Brain magnetic resonance imaging was performed in 102 patients, and 74 patients whose image data were available to assess CMBs were enrolled. ⋯ Cox regression analysis adjusting age and operative risk did not show that CMB was a significant risk factor for all-cause death and major adverse event. Patients with CMB were older than those without, and microbleeds were associated with antiplatelet therapy, staphylococcal infection, and prosthetic valve endocarditis. However, the mid-term clinical outcomes of patients with CMB and those without were comparable.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Case ReportsPartition of Common Atrioventricular Valve in a Patient With Dextrocardia and Univentricular Circulation.
Long-term outcomes in children with atrioventricular septal defect (AVSD) and univentricular palliation are of concern, with <60% survival at 25 years.1 Common atrioventricular valves (AVV) often become insufficient in patients with univentricular physiology, leading to heart failure.1,2 We have recently observed that outcomes of children with AVSD who reach Fontan circulation are not as bad as previously thought, provided that the AVV remains competent.1 Common AVV surgery is associated with substantial mortality and reoperation rates.3 Although successful AVV repair is associated with better survival and freedom from reoperation, good quality repair is difficult to achieve in univentricular circulation,3 especially in patients with dextrocardia.4 Herein, we report a patient with unbalanced AVSD and dextrocardia who underwent AVV repair using the "polytetrafluoroethylene (Gore-Tex, W. L. Gore & Associates, Flagstaff, AZ) bridge" technique5 with excellent early outcome.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Comparative StudyTetralogy of Fallot in the Current Era.
Only few studies have reported long-term outcome of the transatrial-transpulmonary approach in the current era of management of tetralogy of Fallot (ToF). We investigated 15-year outcome of correction via a transatrial-transpulmonary approach in a large cohort of successive patients operated in the 21st century. All infant ToF patients undergoing transatrial-transpulmonary ToF correction between 2000 and 2015 were included (N = 177, 106 male, median follow-up 7.1 (interquartile range 3.0-10.9) years. ⋯ Overall mortality was 2.8%; mortality rates were higher in premature/dysmature newborns (0.7% vs 9.5%; P < 0.001). Although the 15-year outcome of the transatrial-transpulmonary approach in terms of postoperative complications and mortality rates is excellent, the high incidence of moderate and severe PR is worrisome. Valve-sparing surgery was associated with a substantially lower incidence of PR, yet was surgically not possible in the majority of patients.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Recidivism Is the Leading Cause of Death Among Intravenous Drug Users Who Underwent Cardiac Surgery for Infective Endocarditis.
The proportional incidence of intravenous drug use (IVDU)-associated infective endocarditis (IE) cases requiring surgery has increased significantly, mirroring the national opioid crisis. Recidivism is common but its impact on postoperative outcomes is unclear. We aimed to evaluate short- and mid-term postoperative outcomes associated with recidivism in this population. ⋯ IVDU patients who underwent cardiac surgery for IE experienced higher risks of perioperative adverse events and inferior mid-term survival compared to non-IVDU, despite being younger and having less comorbidities. Deaths in IVDU cohort were predominantly due to recidivism. Efforts to improve long-term outcome of patients presenting with IVDU IE should include drug addiction intervention and other strategies to reduce recidivism.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
The Effect of Preoperative Anemia on Patients Undergoing Cardiac Surgery: A Propensity-Matched Analysis.
It is unknown if anemia in the absence of transfusions is an independent risk factor for adverse outcomes in cardiac surgery, and if correction to higher hemoglobin targets impacts these outcomes. This is a retrospective review of 3848 cardiac surgery patients. Propensity matching was completed using 41 covariates. ⋯ There was a significant increase in low cardiac output in the lower threshold group (P = 0.001). There were no differences in outcomes between those who did and did not receive postoperative transfusions (P > 0.05). Preoperative anemia in the absence of transfusions is a risk factor for morbidity and mortality after cardiac surgery, and there is no evidence that transfusion to higher end cardiopulmonary bypass hemoglobin levels impacted this risk.