The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Risk factors for nonocclusive mesenteric ischemia after elective cardiac surgery.
Nonocclusive mesenteric ischemia (NOMI) may occur after cardiopulmonary bypass. It is crucial to early identify patients who are at risk of developing this complication. The aim of this prospective study was to evaluate perioperative risk factors in a large cohort of patients undergoing elective cardiac surgery. ⋯ A high index of suspicion for NOMI in patients with the above-mentioned risk factors may decrease the diagnostic and therapeutic delay. To identify at-risk patients the developed risk equation is a useful tool with a high specificity.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Pulmonary artery interventions after Norwood procedure: does type or position of shunt predict need for intervention?
Pulmonary artery stenosis is a potential complication after Norwood palliation for hypoplastic left heart syndrome. It is unclear whether the shunt type or position in the Norwood procedure is associated with the risk of the development of pulmonary artery stenosis. We examined the risk of pulmonary artery stenosis and the need for pulmonary artery intervention in children undergoing the Norwood procedure with either the right ventricle to pulmonary artery conduit or modified Blalock-Taussig shunt. ⋯ Consistent with a previous multicenter randomized trial, patients who received a right ventricle to pulmonary artery conduit versus a right ventricle to pulmonary artery have a greater risk of requiring pulmonary artery interventions. Patients with right ventricle to pulmonary artery conduit placement to the right underwent a greater number of pulmonary artery interventions but demonstrated overall improved growth of the branch pulmonary arteries compared with the patients receiving a left-sided right ventricle to pulmonary artery conduit.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Transapical transcatheter aortic valve-in-valve implantation: clinical and hemodynamic outcomes beyond 2 years.
The feasibility of transapical valve-in-valve aortic valve implantation into a failed aortic surgical bioprosthesis has been confirmed. The purpose of the present study was to investigate the clinical and hemodynamic outcomes more than 2 years after transapical valve-in-valve aortic valve implantation. ⋯ Transapical valve-in-valve aortic valve implantation provides good clinical outcomes and stable valve function beyond 2 years of follow-up. The best hemodynamic and clinical outcomes can be achieved in the patients with a surgical valve size of 25 mm or greater. Valve-in-valve aortic valve implantation could become a viable approach for selected high-risk patients with failed surgical bioprostheses.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Stentless root bioprosthesis for repair of acute type A aortic dissection.
The superior hemodynamics and excellent long-term clinical performance of stentless xenografts are well described. However, the early and midterm clinical outcomes of stentless valves in patients with acute type A dissection are widely unknown. The current study evaluated the early and midterm clinical outcomes of stentless bioprosthesis for repair of acute type A aortic dissection. ⋯ Stentless valve implantation can be accomplished with satisfactory early and midterm clinical outcomes and is a valuable option in patients with acute aortic dissection who require root replacement.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta.
The incidence of stroke in patients undergoing coronary artery bypass grafting increases sharply in the face of significant atherosclerotic disease of the ascending aorta. We use a technique that allows full revascularization for this cohort of patients, while minimizing cerebral embolic risk. ⋯ We have found that clampless fibrillating heart surgery with circulatory arrest for proximal anastomoses is a safe and effective technique for revascularizing patients with significant ascending aortic disease who are at high risk for cerebral embolic complications.