The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2016
Insights from complex aortic surgery with a Streamliner device for aortic arch repair (STAR).
Aortic arch aneurysms and thoracoabdominal aortic arch aneurysms are technically challenging to manage by established surgical and endovascular methods. The Streamliner Multilayer Flow Modulator device (Cardiatis, Isnes, Brussels, Belgium) offers an unorthodox option for these high-risk cases. The Streamliner device for aortic arch repair (STAR) study investigated complex aneurysm cases managed by the Streamliner Multilayer Flow Modulator device and offers an analytic solution for a clinical dilemma. ⋯ The Streamliner Multilayer Flow Modulator device is a new technology that can manage complex aortic arch aneurysms and thoracoabdominal aortic arch aneurysms with favorable clinical outcomes if it is performed under instructions for use. Careful procedure planning and perioperative virtual stent placement will avoid foreshortening, prevent inadequate stent overlap lengths, and provide insight into the sufficient numbers of required implanted devices.
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J. Thorac. Cardiovasc. Surg. · Nov 2016
Outcome and performance of bioprosthetic pulmonary valve replacement in patients with congenital heart disease.
The goal of this single-center series was to assess differences in reintervention by the type of valve used for surgical bioprosthetic pulmonary valve replacement and to identify independent predictors of reintervention. ⋯ Bioprosthetic pulmonary valve replacement in patients with congenital heart disease has excellent short-term outcomes, but children have an approximately 5-fold greater risk of reintervention than adults. Independently of age, reintervention rates vary by valve type. These differences may be important in valve selection and follow-up.
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J. Thorac. Cardiovasc. Surg. · Nov 2016
Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease.
We aimed to further validate the vasoactive-ventilation-renal score as a predictor of outcome in patients recovering from surgery for congenital heart disease. We also sought to determine the optimal time point within the early recovery period at which the vasoactive-ventilation-renal score should be measured. ⋯ In a heterogeneous population of patients undergoing surgery for congenital heart disease, the novel vasoactive-ventilation-renal score calculated in the early postoperative recovery period can be a strong predictor of prolonged hospital length of stay.
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J. Thorac. Cardiovasc. Surg. · Nov 2016
The cervicosternolaparotomy approach for the treatment of graft dysfunction after retrosternal esophageal reconstruction for caustic injuries.
The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for caustic injuries. ⋯ Cervicosternolaparotomy during revision surgery for graft dysfunction is reliable, is associated with low morbidity and mortality, and has good results.
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J. Thorac. Cardiovasc. Surg. · Nov 2016
EditorialWhy surgery won the SYNTAX trial and why it matters.
The Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) trial cause of death analysis shows that cardiac death due to myocardial infarction is 10 times higher with percutaneous coronary intervention than coronary artery bypass grafting in the higher-risk patients. There was a clear advantage for surgery in the prevention of death in both the intermediate and high SYNTAX score groups with 3-vessel disease and in the high SYNTAX score group with left main disease, and that incremental advantage is statistically significant and widening with time, which should be transparently communicated to patients.