The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Comparative StudyA study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery Database.
Antegrade cerebral perfusion and hypothermic circulatory arrest, with or without retrograde cerebral perfusion, are 2 major types of brain protection that are used during aortic arch surgery. We conducted a comparative study of these methods in patients undergoing total arch replacement to evaluate the clinical outcomes in Japan, based on the Japan Adult Cardiovascular Surgery Database. ⋯ Hypothermic circulatory arrest/retrograde cerebral perfusion and antegrade cerebral perfusion provide comparable clinical outcomes with regard to mortality and stroke rates, but hypothermic circulatory arrest/retrograde cerebral perfusion resulted in a higher incidence of prolonged intensive care unit stay. Antegrade cerebral perfusion might be preferred as the brain protection method for complicated aortic arch procedures.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Aortic arch replacement without circulatory arrest or deep hypothermia: the "branch-first" technique.
Although current developments in aortic arch replacement have demonstrated progressively improving mortality, cerebral morbidity remains significant. We describe a "branch-first" technique that avoids circulatory arrest and profound hypothermia, yielding excellent survival and low cerebral morbidity. ⋯ The "branch-first" technique described brings us closer to the goal of arch surgery with cerebral, vital organ, and survival outcomes similar to those we expect from ascending aortic and root procedures.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
ReviewFrozen elephant trunk surgery in acute aortic dissection.
Acute aortic dissection is a catastrophic condition, for which emergency surgery is the mainstay of therapy. In approximately 70% of patients who survive surgery, a dissected distal aorta remains, posing a risk of late aneurysmal degeneration, rupture, and malperfusion, and secondary extensive interventions are often required. ⋯ The FET technique is a promising approach in patients with acute dissection. Solid long-term data are warranted to validate the assumed short- and long-term benefits, but we believe that thoughtful patient selection criteria remain crucial.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
ReviewThoracic endovascular aortic repair versus open surgery for type-B chronic dissection.
An aging population, increased awareness, high-resolution imaging, and improving access to care all mean that more people are being diagnosed with acute aortic dissection. A better understanding of the role of initial medical therapy, improved surgical techniques, and the addition of endovascular approaches to the treatment algorithm, have resulted in more patients surviving the acute phase of disease. During the chronic phase, patients with residual dissection are challenged by the competing risks of reoperation or death. ⋯ Despite encouraging results for thoracic endovascular aortic repair of acute type-B dissection, chronic type-B dissection poses unique challenges that make application of endovascular technology more difficult. As our understanding of the disease and its natural history evolves, the ways in which these 2 methods of treatment complement each other need to be better understood. The benefits and limitations of each therapy, and how and when to apply each in the setting of chronic distal dissection, are discussed.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Comparative StudyEarly effects of transcatheter aortic valve implantation and aortic valve replacement on myocardial function and aortic valve hemodynamics: insights from cardiovascular magnetic resonance imaging.
There remains a paucity of mechanistic data on the effect of transcatheter aortic valve implantation (TAVI) on early left and right ventricular function and quantitative aortic valve regurgitation. We sought to assess and compare the early effects on myocardial function and aortic valve hemodynamics of TAVI and aortic valve replacement (AVR) using serial cardiovascular magnetic resonance (CMR) imaging and echocardiography. ⋯ There was no significant difference in early left ventricular systolic function between techniques. Whereas right ventricle systolic function was preserved in the AVR group, it was significantly impaired early after TAVI, possibly reflecting a clinically important pathophysiologic consequence of paravalvular aortic regurgitation.