The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2008
Randomized Controlled Trial Comparative StudyDesign and rationale of a randomized trial comparing the Blalock-Taussig and right ventricle-pulmonary artery shunts in the Norwood procedure.
The initial palliative procedure for patients born with hypoplastic left heart syndrome and related single right ventricle anomalies, the Norwood procedure, remains among the highest risk procedures in congenital heart surgery. The classic Norwood procedure provides pulmonary blood flow with a modified Blalock-Taussig shunt. Improved outcomes have been reported in a few small, nonrandomized studies of a modification of the Norwood procedure that uses a right ventricle-pulmonary artery shunt to provide pulmonary blood flow. Other nonrandomized studies have shown no differences between the two techniques. ⋯ This study will make an important contribution to the care of patients with hypoplastic left heart syndrome and related forms of single, morphologically right ventricle. It also establishes a model with which other operative interventions for patients with congenital cardiovascular malformations can be evaluated in the future.
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J. Thorac. Cardiovasc. Surg. · Oct 2008
Multicenter Study Comparative StudyThe short esophagus: intraoperative assessment of esophageal length.
To define the frequency and predictors of short esophagus in a case series of patients undergoing antireflux surgery. ⋯ True short esophagus is present in about 20% of patients undergoing routine antireflux surgery. Radiology, severity, and duration of symptoms are predictors of true foreshortening.
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J. Thorac. Cardiovasc. Surg. · Oct 2008
Randomized Controlled TrialThe role of temporary biventricular pacing in the cardiac surgical patient with severely reduced left ventricular systolic function.
The objective was to evaluate the effects of atrial synchronous biventricular pacing in postoperative patients with severe cardiomyopathy. ⋯ Pacing mode affects stroke volume in patients with severe cardiomyopathy. Atrial synchronous biventricular pacing was helpful in a minority, but in 41% it compromised stroke volume.
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J. Thorac. Cardiovasc. Surg. · Oct 2008
Comparative StudyReoperative aortic root and transverse arch procedures: a comparison with contemporaneous primary operations.
Long-term survival and risk factors affecting outcome after reoperative root/ascending aorta and transverse arch procedures have not been clearly described. ⋯ In this series, reoperations in the transverse arch carry the same risk as primary arch procedures, but a higher operative mortality is seen with reoperative than with primary root/ascending aorta procedures. The long-term outlook is better for patients undergoing root/ascending operations than for patients undergoing aortic arch operations, with no difference in the longevity of patients undergoing primary procedures versus reoperations.
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J. Thorac. Cardiovasc. Surg. · Oct 2008
Randomized Controlled TrialPlatelet activity and aspirin efficacy after off-pump compared with on-pump coronary artery bypass surgery: results from the prospective randomized trial PRAGUE 11-Coronary Artery Bypass and REactivity of Thrombocytes (CABARET).
Changes in hemostasis after off-pump coronary artery bypass grafting are still being discussed. There is a lack of information about platelet activity and aspirin efficacy after coronary artery bypass grafting. The aim of this study was to assess and compare platelet activity and aspirin efficacy early and late after off-pump and on-pump coronary artery bypass grafting. ⋯ The platelet activity is higher in the early postoperative period in off-pump compared with on-pump coronary artery bypass grafting. The present aspirin strategy seems to be insufficient in the early postoperative period, irrespective of the surgical technique used.