The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Endovascular repair of complicated chronic distal aortic dissections: intermediate outcomes and complications.
Patients with chronic distal aortic dissection (CDAD) remain at high risk for late aorta-related events and reinterventions, and the ideal management strategy remains undefined. Open surgical procedures carry morbidity, but scant data for thoracic endovascular aortic repair (TEVAR) of CDAD exist. This study reports our intermediate-term results with TEVAR for complicated CDAD. ⋯ Management of complicated CDAD remains challenging for clinicians. TEVAR is a reasonable treatment modality for dissections limited to the thoracic aorta and for prevention of focal aortic growth in extensive dissections. Late complications and the need for secondary interventions emphasize the complexity of this patient population and the need for long-term follow-up.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Case ReportsSurgical conversion after thoracic endovascular aortic repair.
Improved early and late outcomes of thoracic endovascular aortic repair compared with open repair have changed the therapeutic paradigm of thoracic aortic lesions. However, rare but serious complications due to device failure or adverse events may occur, requiring conversion to open repair. ⋯ Complications due to device failure or adverse events may occur after thoracic endovascular aortic repair, requiring conversion to open repair. Our experience suggests that in some clinical or anatomic situations, caution should be recommended when offering endovascular procedures to patients with thoracic aortic diseases. Open conversion can be performed with encouraging results by a team experienced in the management of thoracic aortic diseases. With the increasing use of thoracic endovascular aortic repair, more patients will present with indications of surgical conversion.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival.
The treatment of patients with ischemic cardiomyopathy and concomitant mitral regurgitation can be challenging and is associated with reduced long-term survival. It is unclear how mitral valve repair versus replacement affects subsequent outcome. Therefore, we conducted this study to understand the predictors of mortality and to delineate the role of mitral valve repair versus replacement in this high-risk population. ⋯ Survival after combined coronary artery bypass grafting and mitral valve surgery in patients with ischemic cardiomyopathy (left ventricular ejection fraction ≤ 45%) and mitral regurgitation is compromised and mostly influenced by factors related to the patient's condition at the time of surgery. The specifics of mitral valve repair versus replacement did not seem to affect survival.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: a prospective study.
Our objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs. ⋯ In neonatal and infant open heart repairs, technical performance score is one of the main predictors of postoperative morbidity. Outcomes are not affected by intraoperative adverse events, including surgical revisions, provided technical performance score is at least adequate.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Comparative StudyReversible pulmonary trunk banding. VI: Glucose-6-phosphate dehydrogenase activity in rapid ventricular hypertrophy in young goats.
Increased myocardial glucose-6-phosphate dehydrogenase (G6PD) activity occurs in heart failure. This study compared G6PD activity in 2 protocols of right ventricle (RV) systolic overload in young goats. ⋯ Continuous systolic overload for ventricle retraining causes RV dysfunction and upregulation of myocardial G6PD activity, which can elevate levels of free radicals by NADPH oxidase, an important mechanism in the pathophysiology of heart failure. Intermittent systolic overload promotes a more efficient RV hypertrophy, with better preservation of myocardial performance and and less exposure to hypertrophic triggers.