The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2011
Results of matching valve and root repair to aortic valve and root pathology.
For patients with aortic root pathology and aortic valve regurgitation, aortic valve replacement is problematic because no durable bioprosthesis exists, and mechanical valves require lifetime anticoagulation. This study sought to assess outcomes of combined aortic valve and root repair, including comparison with matched bioprosthesis aortic valve replacement. ⋯ Valve preservation (rather than replacement) and matching root procedures have excellent early and long-term results, with increasing survival benefit at 7 years and fewer reoperations by 12 years. We recommend this procedure for experienced surgical teams.
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J. Thorac. Cardiovasc. Surg. · Dec 2011
Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair.
To assess root replacement and annular stabilization in bicuspid aortic valve repair, we compared results of reimplantation technique versus subcommissural annuloplasty or no annuloplasty. ⋯ In bicuspid aortic valve repair, root replacement with the reimplantation technique stabilizes the ventriculoaortic junction, improves valve mobility (low gradient), and is associated with improved outcomes.
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J. Thorac. Cardiovasc. Surg. · Dec 2011
Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannulation.
The objective was to report our experience with a simplified procedure of ascending aorta and hemiarch replacement with a stent-graft elephant trunk in type A dissections. The efficacy of innominate artery cannulation was investigated. ⋯ The simplified procedure of ascending aorta and hemiarch replacement with a stent-graft elephant trunk performed by using innominate artery cannulation is safe and effective in patients with acute type A dissection without involvement of 3 vessels of the arch.
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J. Thorac. Cardiovasc. Surg. · Dec 2011
Complete removal as a routine treatment for any cardiovascular implantable electronic device-associated infection.
Pacemaker and implantable cardioverter defibrillator lead endocarditis mandates removal of all foreign material. In supposedly limited (pocket) infections, such a radical approach is still controversial. Thus, some patients are potentially exposed to persistent and recurrent infection because of retained material. Procedural risks and the success of eradicating infection were examined if involvement of the complete system was assumed in any cardiovascular implantable electronic device infection and complete removal was thus mandatory. ⋯ Complete removal of prosthetic material in any cardiovascular implantable electronic device infection is safe and associated with low morbidity and mortality. Success of eradicating infection is high if all system components are removed. Temporary pacing in dependent patients may be performed safely on an outpatient basis.