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
Survival probability loss from percutaneous coronary intervention compared with coronary artery bypass grafting across age groups.
Whether the survival benefit from coronary artery bypass grafting (CABG), compared with percutaneous coronary intervention (PCI), for multivessel disease extends to the older segment of the population remains unclear. We aimed to investigate whether the effect on survival of PCI compared with CABG is related to the age of the patient. ⋯ Compared with PCI, CABG leads to a significant reduction in late-phase mortality across all age groups.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Comparative Studydel Nido versus Buckberg cardioplegia in adult isolated valve surgery.
del Nido solution is a non-glucose-based, single-dose cardioplegic solution with few data supporting its safety in adults. We hypothesized that it and Buckberg solution offer myocardial protection of equivalent safety for isolated adult valve surgery. ⋯ del Nido solution can be used safely and effectively as an alternative to Buckberg solution in adult isolated valve surgery and is associated with lower insulin requirements and potential time and cost savings.