The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Recurrence of mitral regurgitation after partial versus complete mitral valve ring annuloplasty for functional mitral regurgitation.
Both partial and complete annuloplasty rings are used for mitral valve repair for patients with functional mitral regurgitation (FMR). We sought to determine if recurrence of mitral regurgitation (MR) is affected by the type of ring used. ⋯ The use of complete mitral annuloplasty rings provides improved freedom from recurrent MR in patients with FMR.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Long-term outcomes of patients with diabetes receiving bilateral internal thoracic artery grafts.
Bilateral internal thoracic artery (BITA) grafting in patients with diabetes are controversial because of increased risk of sternal infection. On the other hand, patients with diabetes may benefit from BITA grafts because of the associated improved survival. This study evaluated factors affecting early and long-term outcomes for better selection of patients with diabetes for BITA grafts. ⋯ BITA grafts are safe in patients with diabetes. Favorable short- and long-term outcomes outweigh increased sternal infection risk.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Effects of lack of pulsatility on pulmonary endothelial function in the Fontan circulation.
Continuous flow in the Fontan circulation results in impairment of pulmonary artery endothelial function, increased pulmonary arterial resistance, and, potentially, late failure of Fontan circulation. We investigated the mechanisms of vascular remodeling and altered vascular reactivity associated with chronic privation of pulsatility on pulmonary vasculature. ⋯ In a chronic model of unilateral cavopulmonary shunt, pulsatility loss resulted in an altered endothelial-dependant vasorelaxation response of the pulmonary arteries. Micropulsatility limited the effects of pulsatility loss. These results are of importance for potential therapies against pulmonary hypertension in the nonpulsatile Fontan circulation, by retaining accessory pulmonary flow or pharmaceutical modulation of nonendothelial-dependant pulmonary vasorelaxation.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Control of ventricular unloading using an electrocardiogram-synchronized Thoratec paracorporeal ventricular assist device.
Current pulsatile ventricular assist devices operate asynchronous with the left ventricle in fixed-rate or fill-to-empty modes because electrocardiogram-triggered modes have been abandoned. We hypothesize that varying the ejection delay in the synchronized mode yields more precise control of hemodynamics and left ventricular loading. This allows for a refined management that may be clinically beneficial. ⋯ The timing of pump ejection in synchronized mode yields control over left ventricular energetics and can be a method to achieve gradual reloading of a recoverable left ventricle. The traditionally suggested counterpulsation is not optimal in ventriculo-aortic cannulation when maximum unloading is desired.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
EditorialCardiothoracic-themed core surgical training programs in Scotland.
Cardiothoracic surgery generates an impression that only the most committed should pursue it. The book TSRA Review of Cardiothoracic Surgery (Thoracic Surgery Residents Association) is organized around topics core surgical trainees (ie, residents) are expected to understand and master, particularly as surgical selection and training has undergone recent change.