The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Randomized Controlled Trial Comparative StudyTranscatheter (TAVR) versus surgical (AVR) aortic valve replacement: occurrence, hazard, risk factors, and consequences of neurologic events in the PARTNER trial.
All neurologic events in the PARTNER randomized trial comparing transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (AVR) were analyzed. ⋯ After either treatment, there were 2 distinct hazard phases for neurologic events that were driven by different risk factors. Neurologic complications occurred more frequently after TAVR than AVR early, but thereafter the risk was influenced by patient- and disease-related factors.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Pseudoprolapse of the anterior leaflet in chronic ischemic mitral regurgitation: identification and repair.
Recurrence rates as high as 30% have been observed 6 months after treatment of chronic ischemic mitral regurgitation (CIMR) with isolated annuloplasty. We postulated that the high early recurrence rates resulted from the presence of untreated pseudoprolapse of the anterior leaflet. ⋯ Effective repair of CIMR should include surgical techniques to correct pseudoprolapse of the anterior leaflet, when present. The selective addition of Gore-Tex neochordae to an undersized annuloplasty nearly eliminates recurrent regurgitation after mitral valve repair for CIMR.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Multicenter StudyContemporary outcomes for surgical mitral valve repair: a benchmark for evaluating emerging mitral valve technology.
The emergence of transcatheter approaches to mitral valve (MV) repair has focused attention on outcomes after surgical MV repair. Results from the EVEREST II trial demonstrated worse short-term major adverse event (MAE) rates for surgical repair. This study analyzes contemporary outcomes of surgical MV repair to establish a benchmark for future therapeutic comparisons. ⋯ In the current era, patients undergoing surgical MV repair have low mortality. MAE rate was largely due to postoperative atrial fibrillation. These results may help to stratify which patients may be best served with newer technologies.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Mitral valve reconstruction in Barlow disease: long-term echographic results and implications for surgical management.
Owing to the complexity of the underlying lesions, Barlow disease remains a challenge for surgeons performing mitral valve repair. We aimed to assess whether our most recent results involving several surgeons were comparable with those of a previous experience in which mitral valve repair was performed by a more limited group of surgeons. ⋯ Provided that the fundamental principles of mitral valve reconstruction are respected, the surgical techniques are highly reproducible with good long-term results, similar to those published during the pioneering phase of this surgery.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Bilateral internal thoracic artery grafting improves long-term survival in patients with reduced ejection fraction: a propensity-matched study with 30-year follow-up.
Bilateral internal thoracic artery (BITA) grafting has been shown to improve long-term survival after coronary artery bypass grafting. However, there has been reluctance to use this technique in higher-risk patients. Patients with reduced ejection fraction (EF) have been shown to present a higher operative risk and reduced long-term survival. We studied the perioperative and long-term results of BITA versus single internal thoracic artery grafting (SITA) in a large population of patients with reduced EF in whom BITA grafting was broadly applied. ⋯ Broadly applied BITA compared with SITA grafting in propensity-matched patients provides enhanced long-term survival with no increase in operative mortality or morbidity for patients with normal and reduced EF. The expanded use of BITA grafting should be seriously considered.