The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2011
Comparative StudyEffects of different annuloplasty ring types on mitral leaflet tenting area during acute myocardial ischemia.
The study objective was to quantify the effects of different annuloplasty rings on mitral leaflet septal-lateral tenting areas during acute myocardial ischemia. ⋯ In response to acute left ventricular ischemia, disease-specific functional/ischemic mitral regurgitation rings (Edwards IMR ETLogix, GeoForm) more effectively reduced posterior mitral leaflet area, but not anterior mitral leaflet tenting area, compared with true-sized physiologic rings (Carpentier-Edwards Physio). Despite its radical 3-dimensional shape and greater amount of mitral annular septal-lateral downsizing, the GeoForm ring did not reduce tenting areas more than the Edwards IMR ETLogix ring, suggesting that further reduction in tenting areas in patients with FMR/IMR may not be effectively achieved on an annular level.
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J. Thorac. Cardiovasc. Surg. · Feb 2011
Intermediate-term results of a nonresectional dynamic repair technique in 662 patients with mitral valve prolapse and mitral regurgitation.
A nonresectional technique has been developed for repair of mitral leaflet prolapse causing mitral regurgitation. Polytetrafluoroethylene chordae are used for correction of edge misalignment of the prolapsed mitral leaflet. New chordal length is adjusted during progressive left ventricular inflation to systolic pressure. Annular sizing is determined dynamically after leaflet edge alignment is accomplished to produce an optimal zone of predefined leaflet apposition. The aim of this study was to document the 8- to 10-year durability of this nonresectional approach. ⋯ This study confirms that mitral regurgitation from mitral leaflet prolapse can be repaired in all cases by a nonresectional technique provided that accurate dynamic evaluation of chordal length and annular sizing is achieved. The intermediate-term results are durable.
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J. Thorac. Cardiovasc. Surg. · Feb 2011
Midterm results with thoracic endovascular aortic repair for chronic type B aortic dissection with associated aneurysm.
Thoracic endovascular aortic repair for chronic type B aortic dissection with associated descending thoracic aneurysm remains controversial. Concerns include potential ischemic complications due to branch vessel origin from the chronic false lumen and continued retrograde false lumen/aneurysm sac pressurization via fenestrations distal to implanted endografts. The present study examines midterm results with thoracic endovascular aortic repair for chronic (>2 weeks) type B aortic dissection with associated aneurysm to better understand the potential role of thoracic endovascular aortic repair for this condition. ⋯ Thoracic endovascular aortic repair for chronic type B dissection with associated aneurysm is safe and effective at midterm follow-up. Aneurysm sac/false lumen pulse pressure measurements demonstrate a significant reduction in false lumen endotension, thus ruling out clinically significant persistent retrograde false lumen perfusion and provide proof of concept for a thoracic endovascular aortic repair-based approach. Longer-term follow-up is needed to determine the durability of thoracic endovascular aortic repair for this aortic pathology.
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J. Thorac. Cardiovasc. Surg. · Feb 2011
The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades.
Postoperative atrial fibrillation is the most common complication after cardiac surgery. A variety of postoperative atrial fibrillation risk factors have been reported, but study results have been inconsistent or contradictory, particularly in patients with preexisting atrial fibrillation. The incidence of postoperative atrial fibrillation was evaluated in a group of 10,390 patients undergoing cardiac surgery among a comprehensive range of risk factors to identify reliable predictors of postoperative atrial fibrillation. ⋯ The persistence of the problem of postoperative atrial fibrillation and the modest predictability using common risk factors suggest that limited progress has been made in understanding its cause and treatment.
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J. Thorac. Cardiovasc. Surg. · Feb 2011
Minimally invasive aortic valve replacement in octogenarian, high-risk, transcatheter aortic valve implantation candidates.
Risk-stratifying algorithms are currently used to determine which patients may be at prohibitive risk for surgical aortic valve replacement, and thus candidates for transcatheter aortic valve implantation. Minimally invasive surgical approaches have been successful in reducing morbidity and improving survival after aortic valve replacement, especially in octogenarians. We documented outcomes after minimally invasive aortic valve replacement in high-risk octogenarians who may be considered candidates for percutaneous/transapical aortic valve replacement. ⋯ Patients thought to be high-risk candidates for surgical aortic valve replacement have excellent outcomes after minimally invasive surgery with long-term survival that is no different than that of an age- and gender-matched US population. These data provide a benchmark against which outcomes of transcatheter aortic valve implantation could be compared.