The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Randomized Controlled TrialTen-year outcomes of patients randomized to surgery, angioplasty, or medical treatment for stable multivessel coronary disease: effect of age in the Medicine, Angioplasty, or Surgery Study II trial.
With progressive aging, coronary artery disease has been diagnosed at more advanced ages. Although patients aged 65 years or more have been referred to surgical or percutaneous coronary interventions, the best option for coronary artery disease treatment remains uncertain. The current study compared the 3 treatment options for coronary artery disease in patients aged 65 years or more and analyzed the impact of age in treatment options. ⋯ In this analysis, treatment options for patients aged 65 years or more who have coronary artery disease yield similar overall survival. However, coronary artery bypass grafting was associated with fewer coronary events, and percutaneous coronary intervention was associated with a higher incidence of myocardial infarction.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Comparative StudyImpact of ABO compatibility on outcomes after heart transplantation in a national cohort during the past decade.
Immunologic incompatibility has implications for primary graft failure, rejection, and survival in heart transplantation. To our knowledge, this is the first large cohort study investigating the impact of ABO-compatible versus identical blood type matching on post heart transplantation survival. ⋯ ABO-compatible transplantation does not result in adverse outcomes with respect to graft survival. Blood type O donor grafts, however, were associated with decreased survival. This has important implications for current graft allocation policies, particularly for type B recipients.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Aortic root conservative repair of acute type A aortic dissection involving the aortic root: fate of the aortic root and aortic valve function.
Despite many studies about aortic valve function and aortic root geometry after conservative aortic root repair of acute type A aortic dissection, the results are not always consistent or conclusive. This study aims to evaluate aortic root diameter and aortic valve function after surgery for acute type A aortic dissection involving the aortic root. ⋯ Conservative aortic root repair of acute type A aortic dissection demonstrates acceptable long-term clinical outcomes. However, more aggressive approaches should be considered for patients who have aortic root dilatation because of the risk of developing a root aneurysm after surgery.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Rapid 2-stage Norwood I for high-risk hypoplastic left heart syndrome and variants.
Preoperative comorbidities (PCMs) are known risk factors for Norwood stage I (NW1). We tested the hypothesis that short-term bilateral pulmonary arterial banding (bPAB) before NW1 could improve the prognosis of these high-risk patients. ⋯ Optimizing the balance between the pulmonary and systemic blood flow with a short period of bPAB and ductal patency can improve the perioperative conditions of high-risk patients before NW1. Those who survived bPAB and underwent NW1 had early mortality and 1-year survival comparable to the standard risk category, despite the severity of their initial condition. A rapid 2-stage NW1 strategy with bPAB and prostaglandin to maintain ductal patency can avoid the risks of suboptimal palliation and vascular injuries associated with hybrid procedures.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Prevention of retrosternal adhesion by novel biocompatible glue derived from food additives.
Postoperative retrosternal adhesion increases the risk of cardiac injury during cardiac reoperation. We created a novel biodegradable glue called "Lydex" that is derived from food additives. The purpose of this study is to evaluate this new biomaterial's biocompatibility and its preventive effect on retrosternal adhesion. ⋯ Our findings indicate that Lydex reduces retrosternal adhesion and attenuates the progression of fibrosis with excellent biocompatibility. Lydex is a next-generation substance for safer cardiac reoperation, with excellent capability for preventing adhesion, biocompatible and biodegradable properties, and lower potential for viral infections related to human plasma or other animal-derived products.