The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2009
Multicenter StudyImpact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: a multicenter analysis.
Do prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis. ⋯ Multicenter analysis confirms that a history of multiple previous percutaneous coronary interventions increases in-hospital mortality and the incidence of major adverse cardiac events after subsequent coronary artery bypass grafting. Critical discussion of the treatment strategy in these patients is warranted.
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J. Thorac. Cardiovasc. Surg. · Apr 2009
Randomized Controlled TrialDiazoxide protects myocardial mitochondria, metabolism, and function during cardiac surgery: a double-blind randomized feasibility study of diazoxide-supplemented cardioplegia.
The study was designed to assess whether diazoxide-mediated cardioprotection might be used in human subjects during cardiac surgery. ⋯ Supplementing blood cardioplegia with diazoxide is safe and improves myocardial protection during cardiac surgery, possibly through its influence on the mitochondria.
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J. Thorac. Cardiovasc. Surg. · Apr 2009
Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair.
We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract. ⋯ Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle-to-pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention.
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J. Thorac. Cardiovasc. Surg. · Apr 2009
Comparative StudyEarly planned institution of biventricular mechanical circulatory support results in improved outcomes compared with delayed conversion of a left ventricular assist device to a biventricular assist device.
It is generally accepted that patients who require biventricular assist device support have poorer outcomes than those requiring isolated left ventricular assist device support. However, it is unknown how the timing of biventricular assist device insertion affects outcomes. We hypothesized that planned biventricular assist device insertion improves survival compared with delayed conversion of left ventricular assist device support to biventricular assist device support. ⋯ When patients at high risk for failure of isolated left ventricular assist device support are identified, proceeding directly to biventricular assist device implantation is advised because early institution of biventricular support results in dramatic improvement in survival.
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J. Thorac. Cardiovasc. Surg. · Apr 2009
Safer aortic crossclamping during short-term moderate hypothermic circulatory arrest for cardiac surgery in patients with a bad ascending aorta.
Cardiac surgery in patients with severely atherosclerotic or porcelain ascending aorta is technically challenging, with markedly increased risk of atheroembolism. We describe a technique of meticulous crossclamping of a difficult aorta during short-term moderate hypothermic circulatory arrest. ⋯ Short-term moderate hypothermic circulatory arrest is quite useful for safe aortic crossclamping after internal inspection or debridement in high-risk patients with a severely atherosclerotic aorta.