The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Prognostic factors for aorta remodeling after thoracic endovascular aortic repair of complicated chronic DeBakey IIIb aneurysms.
The use of thoracic endovascular aortic repair (TEVAR) for chronic DeBakey III type b (CDIIIb) aneurysms is controversial. We analyzed the potential prognostic factors affecting aorta remodeling after this procedure. ⋯ Although reentry tears above the celiac trunk were fully covered, the visceral branches and ICAs from the FL and all communicating channels below the celiac trunk kept the FL pressurized and were unfavorable prognostic factors for aorta remodeling after TEVAR for CDIIIb aneurysms.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Comparative StudyResidual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis.
To identify and understand residual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis (IE), we categorized the intraoperative pathologic entities in patients with left-sided IE and correlated the pathology (noninvasive vs invasive) and organism with IE context (affected valve, native vs prosthetic [PVE]) and surgical results. ⋯ During the past decade, we have had low hospital mortality for surgically treated left-sided IE and have neutralized the added risk of PVE. However, outcomes remain worse for mitral versus aortic valve IE, with residual obstacles related to patient factors, inherent mitral valve anatomy in patients with invasive disease, and lack of an alternative mitral valve prosthesis optimal for IE.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Comparative StudyA minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay.
The Cox maze IV procedure has the best results for the surgical treatment of atrial fibrillation. It has been traditionally performed through sternotomy with excellent outcomes, but this has been considered to be too invasive. An alternative approach is to perform a less invasive right anterolateral minithoracotomy. This series compared these approaches at a single center in consecutive patients. ⋯ The Cox maze IV procedure performed through a right minithoracotomy is as effective as sternotomy in the treatment of atrial fibrillation. This approach was associated with fewer complications, decreased mortality and decreased length of stay in the intensive care unit and hospital length of stay.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.
The management of acute type A aortic dissection complicated by coma remains controversial. We previously reported an excellent rate of recovery of consciousness provided aortic repair was performed within 5 hours of the onset of symptoms. This study evaluates the early and long-term outcomes using this approach. ⋯ The early and long-term outcomes as a result of immediate aortic repair for acute type A aortic dissection complicated by coma were satisfactory.