The Journal of thoracic and cardiovascular surgery
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Dual antiplatelet therapy is the cornerstone treatment for patients with acute coronary syndrome. Recent Canadian Guidelines recommend the use of dual antiplatelet therapy for 1 year after coronary artery bypass grafting in patients with acute coronary syndrome, but considerable variability remains. ⋯ Cardiac surgeons exhibit variation in their attitudes and practice patterns toward dual antiplatelet therapy after coronary artery bypass grafting, and in approximately half of cases, their practice does not adhere to current guideline recommendations. New trials focusing on coronary artery bypass grafting cases in their primary analysis and educational initiatives for surgeons that focus on guideline recommendations may be warranted.
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J. Thorac. Cardiovasc. Surg. · Dec 2015
Comparative StudySurvival and right ventricular performance for matched children after stage-1 Norwood: Modified Blalock-Taussig shunt versus right-ventricle-to-pulmonary-artery conduit.
Early survival advantages after Norwood with right-ventricle-(RV)-to-pulmonary-artery conduit (NW-RVPA) over Norwood-operation with a Blalock-Taussig shunt (NW-BT) are offset by concerns regarding delayed RV dysfunction. We compared trends in survival, RV dysfunction, and tricuspid valve regurgitation (TR) between NW-RVPA and NW-BT for propensity-matched neonates with critical left ventricular outflow tract obstruction (LVOTO). ⋯ Among propensity-score-matched neonates with critical LVOTO, NW-RVPA offers superior 6-year survival with no greater prevalence of RV dysfunction or TR than conventional NW-BT operations.
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J. Thorac. Cardiovasc. Surg. · Dec 2015
The impact of 6 weeks of atrial fibrillation on left atrial and ventricular structure and function.
The impact of prolonged episodes of atrial fibrillation on atrial and ventricular function has been incompletely characterized. The purpose of this study was to investigate the influence of atrial fibrillation on left atrial and ventricular function in a rapid paced porcine model of atrial fibrillation. ⋯ In a chronic model of atrial fibrillation, the left atrium demonstrated significant structural remodeling and decreased contractility. These data suggest that early intervention in patients with persistent atrial fibrillation might mitigate against adverse atrial and ventricular structural remodeling.
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J. Thorac. Cardiovasc. Surg. · Dec 2015
Outcomes and risk factors for heart transplantation in children with congenital heart disease.
Heart transplantation in children with underlying congenital heart disease has traditionally been associated with inferior outcomes. We report our single institution experience. ⋯ The outcomes of heart transplantation in children with congenital heart disease have not improved in the current era. Survival was not affected by the underlying anomaly, prior Fontan procedure, or sensitization. Strategies to improve the outcomes in patients with congenital heart disease may need to address selection criteria, transplantation timing, and pretransplant and post-transplant care. The effect of donor-recipient race mismatch warrants further investigation and might affect organ allocation algorithms or immunosuppression management.
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J. Thorac. Cardiovasc. Surg. · Dec 2015
Delayed low pressure at reperfusion: A new approach for cardioprotection.
The aims of this study were to evaluate whether the delayed application of low-pressure reperfusion could reduce lethal reperfusion injury and whether the inhibition of the opening of the mitochondrial permeability transition pore is involved in this protection. ⋯ We demonstrated for the first time that low-pressure reperfusion can reduce lethal myocardial reperfusion injury even when performed 10 to 20 minutes after the initiation of reperfusion.