The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Differential effects of atorvastatin on autophagy in ischemic and nonischemic myocardium in Ossabaw swine with metabolic syndrome.
The perioperative administration of pleomorphic statin drugs has been implicated in improving outcomes after cardiac surgery. Adaptive autophagy is a highly conserved cellular process that allows for the elimination of dysfunctional cell components in response to stress and survival under starving conditions. We sought to investigate the effects of the statin drug atorvastatin on autophagy in ischemic and nonischemic myocardia using a clinically relevant porcine model of metabolic syndrome. ⋯ Atorvastatin administration has differential effects on autophagy in ischemic and nonischemic myocardia. In the setting of metabolic syndrome, atorvastatin stimulates autophagy in nonischemic myocardium while partly inhibiting autophagy in ischemic myocardium. The differential regulation on autophagy may, in part, explain the cardioprotective effect of statins in both ischemic and nonischemic myocardia, and these findings may have implications in the setting of cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Multicenter StudyResults of type II hybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology.
To review the early results of a less invasive, single-stage hybrid arch procedure involving replacement of the ascending aorta, arch debranching, and zone 0 antegrade stent graft deployment. ⋯ This single-stage hybrid arch procedure offers an alternative approach to complex diffuse aortic pathology involving the arch. Replacement of the ascending aorta provides a safe location for zone 0 stent graft deployment, eliminating complications of proximal deployment in a native diseased aorta.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative StudyThe CarboMedics supra-annular Top Hat valve improves long-term left ventricular mass regression.
The present study aimed to identify potential differences in hemodynamic performance between the supra-annular CarboMedics Top Hat valve and the intra-annular CarboMedics standard valve in terms of the long-term left ventricular mass reduction and transvalvular gradients. ⋯ The Top Hat valve surpasses hemodynamically the intra-annular valve. We suggest the supra-annular Top Hat prosthesis can be especially recommended for patients with a small aortic root and severe myocardial hypertrophy.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
The modern Fontan operation shows no increase in mortality out to 20 years: a new paradigm.
Dating back to the first published report of the Fontan circulation in 1971, multiple studies have examined the long-term results of this standard procedure for palliation of single-ventricle heart disease in children. Although the technique has evolved over the last 4 decades to include a polytetrafluorethylene (PTFE) conduit for a large percentage of patients, the long-term outcome has not yet been established. The aim of the current study was to investigate the possibility of a late increasing risk for death after 15 years among patients with a modern Fontan operation and to evaluate late morbidity. ⋯ Early and late survival after a Fontan operation with a PTFE conduit is excellent, with no late phase of increasing death risk after 20 years. Late functional status is good, the need for late reoperation is rare, and thrombotic complications are uncommon on a standard medical regimen including aspirin as the only anticoagulation medication.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative StudyVentriculovascular interactions late after atrial and arterial repair of transposition of the great arteries.
The aim of this study was to compare atrial switch and arterial switch operations for the repair of transposition of the great arteries (TGA), assessing cardiac function and ventriculoarterial (VA) coupling based on cardiac magnetic resonance (CMR) data. Using CMR-derived wave intensity analysis, this study provides a noninvasive comparison of the 2 systemic ventricles and evaluates the subclinical hemodynamic burden of these operations. ⋯ These data highlight reduced aortic distensibility and abnormal VA coupling in repaired TGA. An intraoperational difference was noted in terms of EF and peak FEW, likely reflecting the different nature of the subaortic ventricle.