Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Jun 2014
Perioperative predictors of midterm survival after aortic valve replacement.
Elderly patients with aortic stenosis are under-referred for aortic valve replacement surgery. This study investigated the perioperative factors associated with midterm outcomes in a consecutive series of patients undergoing aortic valve replacement with or without coronary artery bypass graft surgery. ⋯ 5-year survival among octogenarians was 59.2% with an observed 30-day mortality of 1% for aortic valve replacement and 3% for aortic valve replacement with coronary artery bypass. Kaplan-Meier survival analysis showed that age ≥80 years, New York Heart Association functional class III/IV, and left ventricular ejection fraction <35% were significantly associated with increased midterm mortality. Cox regression modeling demonstrated that age ≥80 years was the only significant independent factor associated with midterm mortality; older patients had a 3-fold increase in mortality (adjusted hazard ratio = 3.231, 95% confidence interval: 1.764-5.920, p < 0.0001). While hospital and 30-day mortality were not statistically different between age groups, age ≥80 years was the most powerful predictor of midterm death. These results support early aortic valve replacement with or without coronary artery bypass in aortic stenosis management.
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Gastrointestinal bleeding due to colonic angiodysplasia can be associated with calcified aortic stenosis. This association is referred to as Heyde's syndrome. ⋯ We describe the case of a 46-year-old woman with congestive heart failure related to aortic stenosis, and severe anemia, with multiple angiodysplasias on the ileum and colon. After aortic valve replacement, there were no further episodes of bleeding and her hemoglobin levels normalized.
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Asian Cardiovasc Thorac Ann · May 2014
Randomized Controlled TrialIs steel wire closure of sternotomy better than polyester suture closure?
Median sternotomy is the preferred approach for open heart surgeries. The sternotomy incision is predominantly closed with either steel wire or polyester suture. The type of material used is primarily based on the surgeon's choice, and both materials achieve a good result. No prospective clinical study has been undertaken to evaluate differences in the incidence of wound infection and the degree of pain associated with both techniques. ⋯ The use of polyester suture for sternal closure in adult patients results in increased wound infection, wound pain, and late wound complications, but lower mediastinal drain output.
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Asian Cardiovasc Thorac Ann · May 2014
Left atrial reduction in modified maze procedure with concomitant mitral surgery.
An association between mitral valve disease and atrial fibrillation is common. Modifications of energy sources have simplified surgical ablation. Left atrial size reduction should improve outcomes of the maze operation. ⋯ Radiofrequency ablation is an effective option for treatment of permanent atrial fibrillation concomitant with mitral valve surgery. Atrial reduction to <50 mm improves success. Elimination of atrial fibrillation significantly prolongs patient survival.
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Asian Cardiovasc Thorac Ann · May 2014
Case ReportsInfected pseudoaneurysm following a modified Blalock-Taussig shunt procedure.
A 3-year-old boy with pulmonary atresia with ventricular septal defect, who had undergone placement of a modified Blalock-Taussig shunt, presented with a 1-week history of high fever. Computed tomography showed a pseudoaneurysm at the anastomosis between the right brachiocephalic artery and the graft. After intravenous antibiotic therapy, the pseudoaneurysm and infected graft were resected through a median sternotomy. This report describes successful management of a potentially fatal complication following placement of a modified Blalock-Taussig shunt.