The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2013
A shifting approach to management of the thoracic aorta in bicuspid aortic valve.
The scientific understanding of aortic dilation associated with bicuspid aortic valve (BAV) has evolved during the past 2 decades, along with improvements in diagnostic technology and surgical management. We aimed to evaluate secular trends and predictors of thoracic aortic surgery among patients with BAV in the United States. ⋯ There was a marked increase in the use of thoracic aortic surgery among patients with BAV.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Preoperative multidetector computed tomograpy angiography for planning of minimally invasive robotic mitral valve surgery: impact on decision making.
Minimally invasive mitral valve (MV) surgeries (ie, right thoracotomy and robotic approaches) are preferred for degenerative mitral regurgitation because these procedures result in reduced surgical trauma and recovery time. However, because of peripheral cardiopulmonary bypass, there is risk of embolic complications. We sought to use the strengths of 3-dimensional multidetector computed tomography (MDCT) in assessing aortoiliac atherosclerosis and mitral annular calcification (MAC) and its influence on decision for approach in MV surgery. ⋯ In patients undergoing minimally invasive MV surgery, there is a strong association between presence of significant aortoiliac atherosclerosis, as determined by MDCT and/or MAC and change in surgical approach.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Influence of left ventricular function on development of systolic anterior motion after mitral valve repair.
A hyperkinetic heart has been suggested as a risk factor for systolic anterior motion (SAM) after mitral valve repair, but the influence of preoperative left ventricular (LV) function on the development of SAM has not been elucidated. ⋯ The study indicates that the development of SAM after mitral valve repair is associated with preoperative LV function. A small hyperkinetic heart is considered a risk factor for SAM and should be treated with caution.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Short- and intermediate-term survival after extracorporeal membrane oxygenation in children with cardiac disease.
In children with cardiac disease, common indications for extracorporeal membrane oxygenation (ECMO) include refractory cardiopulmonary resuscitation (E-CPR), failure to separate from cardiopulmonary bypass (OR-ECMO), and low cardiac output syndrome (LCOS-ECMO). Despite established acceptance, ECMO outcomes are suboptimal with a survival between 38% and 55%. We evaluated factors associated with significantly increased survival in cardiac patients requiring ECMO. ⋯ ECMO was successfully used in children with cardiac disease with 73% and 66% short- and intermediate-term survival, respectively. The majority of the survivors had normal function or only a minimal neurodevelopmental deficit.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Anatomic and flow dynamic considerations for safe right axillary artery cannulation.
Neuroprotection is of paramount interest in cardiac surgery. Right axillary artery cannulation is well established in aortic surgery because it significantly improves survival and outcome, but malperfusion of the right brain after direct cannulation has been reported. Anatomically, 4 vessel segments are potentially amenable for cannulation of the subclavian and axillary arteries. Clinical studies vary widely in dissection sites and cannulation techniques. We investigated critical flow dynamics in the right brain caused by arterial inflow after direct cannulation and specified cannulation positions that provide optimal cerebral perfusion. ⋯ Direct cannulation of the right axillary artery can lead to cerebral malperfusion, caused by an obstruction of the vertebral artery's orifice by the arterial cannula or a subclavian steal phenomenon due to flow reversal. The safety of direct axillary artery cannulation can be improved by a well-considered dissecting site and insertion length of the cannula.