Seminars in thoracic and cardiovascular surgery
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Transcatheter aortic valve replacement (TAVR) has been developed as a less-invasive approach to address patients at high risk to extreme risk for surgical aortic valve replacement. The CoreValve US trial enrolled patients with symptomatic severe aortic stenosis into 2 separate cohorts: an extreme-risk cohort and a high-risk cohort. ⋯ The CoreValve high-risk trial is the only randomized trial of TAVR vs surgical aortic valve replacement to show superior survival of TAVR. This was achieved with a numerically lower rate of major stroke and statistically superior changes in aortic valve function from baseline to 1 year.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2014
Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis.
Respiratory complications are the most frequent adverse events in patients undergoing esophagectomy for cancer, and their occurrence may negatively affect postoperative recovery and outcomes. We queried the American College of Surgeons National Surgical Quality Improvement Program dataset to study the rate and influence of pneumonia, unplanned intubation, and ventilator dependency >48 hours on the early outcomes after esophagectomy and risk factors for their development. We included adult patients with an esophageal or gastric cancer diagnosis who were treated with esophagectomy between 2005 and 2012 and grouped them into 2 categories with respect to development of respiratory complications. ⋯ These patients also had statistically significantly higher rates of 30-day mortality and overall morbidity and were more likely to return to the operating room and to stay in the hospital longer. On multivariable analysis, numerous factors, including advanced age, smoking, alcohol use, dyspnea, history of chronic obstructive pulmonary disease, and prolonged operative time, were found to be risk factors for developing respiratory complications. As the development of respiratory complications leads to worse early surgical outcomes after esophagectomy, efforts should be made to prevent their occurrence by identifying patients with significant risk factors.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2014
ReviewCurrent readings: long-term management of patients undergoing successful pediatric cardiac surgery.
As of 2000, more adults than children are alive with congenital heart disease. Each year, more of these adults with congenital heart disease undergo surgery. Adults with congenital heart disease require lifelong surveillance, follow-up imaging, and clinical decision making by appropriately trained and familiar physicians and extenders. ⋯ Although a history of previous cardiac surgery does not independently confer a significant incremental risk of operative mortality, patients with the greatest number of previous surgeries appear to be a higher risk group. Multi-institutional data about adults with congenital heart disease from The Society of Thoracic Surgeons Congenital Heart Surgery Database can be used to estimate prognosis and council patients and their families. The six manuscripts reviewed in this article have been selected to give a flavor of the state of the art in the domain of caring for adults with congenital heart disease and to provide important information about the long term management of patients undergoing successful pediatric cardiac surgery.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2014
ReviewCurrent readings: Aortic valve-sparing operations.
It has been more than 2 decades since aortic valve-sparing operations were introduced to preserve the aortic valve in patients with aortic root aneurysm. Remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, mostly because it preserves the aortic annulus movement during the cardiac cycle. However, several comparative studies have shown that reimplantation of the aortic valve has provided more stable aortic valve function than remodeling of the aortic root. ⋯ Thus, both techniques are useful in preserving the aortic valve. With either technique, restoration of normal aortic annulus and cusp geometry is the single most important technical aspect of these operations. In addition to having a competent valve with no or trivial aortic insufficiency at the end of the operation, there must be no cusp prolapse and the coaptation level of the cusps has to be well above the level of the nadir of the aortic annulus.