The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Case ReportsSurgical correction of aortic valve insufficiency after left ventricular assist device implantation.
New-onset aortic insufficiency (AI) can be encountered after instituting mechanical circulatory support and seems more common and severe with continuous flow (CF) left ventricular assist devices (LVADs) compared with pulsatile devices. Treatment algorithms for de novo, post-LVAD AI have not been well defined. In the present report, we have described 6 patients who underwent aortic valve surgery for new-onset post-LVAD AI. ⋯ Surgical treatment of post-LVAD AI with aortic valve oversewing or leaflet repair or by bioprosthetic aortic valve replacement is effective at restoring functional capacity for CF LVAD patients who develop symptomatic, severe AI and can be performed safely with good results. Various transcatheter approaches to these difficult problems are also available and offer less invasive alternatives to conventional surgery.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Platelet activity measured by a rapid turnaround assay identifies coronary artery bypass grafting patients at increased risk for bleeding and transfusion complications after clopidogrel administration.
We sought to establish a metric for easily estimating bleeding and transfusion risks for cardiac surgery patients after antiplatelet agent use. ⋯ Among clopidogrel-treated CABG patients, preoperative platelet function testing can identify those at increased risk for postoperative bleeding and transfusion.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Comparative StudyAge cutoff for the loss of survival benefit from use of radial artery in coronary artery bypass grafting.
Controversy still exists about the superiority of the radial artery (RA) over the saphenous vein graft (SVG) as a second conduit for surgical myocardial revascularization. We aimed to investigate the presence of any survival benefit from use of the RA and relate it to patients' age. ⋯ The use of the radial artery graft as a second conduit improves all-cause mortality in patients undergoing primary isolated CABG up to the age of 70 years.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Assessment of coronary artery disease risk in 5463 patients undergoing cardiac surgery: when is preoperative coronary angiography necessary?
We sought to critically analyze the routine use of conventional coronary angiography (CCA) before noncoronary cardiac surgery and to assess clinical prediction models that might allow more selective use of CCA in this setting. ⋯ In the absence of angina, previous myocardial infarction, or percutaneous coronary intervention, preoperative CCA identified significant CAD in only one third of patients. Our clinical prediction models could enhance the identification of patients at low risk of significant CAD for whom CCA might potentially be avoided before cardiac surgery. This strategy may improve the efficiency of cardiac surgical care delivery by diminishing procedure-related morbidity and offering significant cost savings.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Comparative StudyMicrovascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump.
To evaluate how pulsed versus nonpulsed cardiopulmonary bypass influences microvascular fluid exchange in an experimental setup combining a nonpulsatile perfusion pump and an intra-aortic balloon pump. ⋯ No significant differences in the fluid extravasation rates were present between pulsed and nonpulsed cardiopulmonary bypass perfusion in the present experimental setup.