The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyOptimal treatment strategy for type A acute aortic dissection with intramural hematoma.
The management strategy for type A acute aortic dissection (AAD) with intramural hematoma (IMH) remains controversial. The aim of this study was to compare the outcomes of emergency surgery and medical treatment for patients with acute type A IMH. ⋯ Emergency surgery for patients with type A IMH showed favorable mortality rates because most of the patients were in hemodynamically stable condition preoperatively. On the other hand, several patients died suddenly during medical care. Emergency surgical treatment may provide a better outcome than medical treatment at the time of onset, even for patients with type A IMH.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Editorial ReviewCurrent era minimally invasive aortic valve replacement: techniques and practice.
Since the first aortic valve replacement through a right thoracotomy was reported in 1993, upper hemisternotomy and right anterior thoracotomy have become the predominant approaches for minimally invasive aortic valve replacement. Clinical studies have documented equivalent operative mortality, less bleeding, and reduced intensive care/hospital stay compared with conventional sternotomy despite longer procedure times. However, comparative trials face challenges due to patient preference, surgeon bias, and the lack of a standardized minimally invasive surgical approach. ⋯ Surgeons interested in learning and performing minimally invasive aortic valve replacement must have expertise in conventional aortic valve replacement at centers with adequate case volumes. A team approach that coordinates efforts of the surgeon, anesthesiologist, perfusionist, and nurses is required to achieve the best clinical outcomes. By first developing fundamental minimally invasive skills using specialized cannulation techniques, neck lines, and long-shafted instruments in the setting of conventional full sternotomy, the safest operative environment is afforded to patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyShould surgical ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium?
One established predictor for failure of surgical ablation for atrial fibrillation is increased left atrial size. Surgeon perception is that surgical ablation in these patients is ineffective and should not be performed. The purpose of this study was to determine whether a larger left atrial size carries a prohibitive risk for failure and embolic events after surgical ablation. ⋯ The large left atrium group had acceptable return to sinus rhythm and sinus rhythm without antiarrhythmic drugs. The embolic stroke rate was low despite the majority of patients not taking anticoagulation. If patients are managed appropriately post-ablation, left atrial size should not be a discouragement when evaluating surgical candidates with atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Outcomes of extracorporeal life support for low cardiac output syndrome after major cardiac surgery.
Extracorporeal life support (ECLS) is a widely accepted modality for the treatment of postoperative low cardiac output syndrome (LCOS) after major cardiac surgery by providing temporary circulatory support for the stunned myocardium. We sought to identify the factors that affect outcomes of ECLS for postoperative LCOS. ⋯ High lactate level before ECLS is an independent predictor of mortality after ECLS, necessitating earlier ECLS implementations before profound lactic acidosis develops. Moreover, nafamostat mesilate should be considered as alternative to heparin to reduce the risk of bleeding in these high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Early clinical and angiographic outcomes after robotic-assisted coronary artery bypass surgery.
Robotic-assisted coronary artery bypass grafting has emerged as an alternative to traditional coronary artery bypass grafting or percutaneous intervention for patients with coronary artery disease. However, the safety and efficacy of this minimally invasive procedure have not been established in large series. ⋯ Robotic-assisted coronary artery bypass grafting is an effective alternative to traditional coronary artery bypass grafting for patients with single or multivessel coronary artery disease, with comparable short-term clinical and angiographic results.