The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Reduced continuous-flow left ventricular assist device speed does not decrease von Willebrand factor degradation.
Nonsurgical bleeding is a frequent complication of continuous-flow left ventricular assist device (LVAD) support. Abnormal von Willebrand factor (vWF) metabolism plays a major role. However, the relationship between LVAD speed and vWF degradation is unknown. Recent evidence has demonstrated that supraphysiologic shear stress from continuous-flow LVADs accelerates vWF degradation and causes an acquired vWF deficiency and bleeding. To manage LVAD-associated bleeding, it has been proposed that reduced LVAD speed may decrease shear stress and thereby reduce pathologic vWF metabolism. However, there are little published data to support this clinical practice. We tested the hypothesis that reduced continuous-flow LVAD speed decreases vWF degradation. ⋯ Reduced LVAD speed (within the clinical operational range) did not significantly decrease vWF degradation in a mock circulatory loop with human blood. During bleeding events, reduced LVAD speed, itself, may not diminish vWF degradation.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Comparative StudyA pulsatile hemodynamic evaluation of the commercially available bifurcated Y-graft Fontan modification and comparison with the lateral tunnel and extracardiac conduits.
Fontan completion, resulting in a total cavopulmonary connection, is accomplished using a lateral tunnel, extracardiac conduit, or bifurcated Y-graft. The use of Y-grafts is hypothesized to provide symmetric hepatic blood flow distribution to the lungs, a factor related to pulmonary arteriovenous malformations. The present study evaluates the hemodynamic performance of the largest commercially available Y-graft cohort to date, highlights 6 representative cases, and compares commercially available Y-graft performance with lateral tunnel/extracardiac conduit connections. ⋯ Commercially available Y-grafts do not inherently provide more balanced hepatic flow distribution than lateral tunnel/extracardiac conduit connections, which are more energetically favorable and less sensitive to pulmonary artery stenosis. Graft type should be considered on an individual basis because hemodynamic performance is based on a combination of factors, including pulmonary flow distribution, pulmonary artery stenosis, and superior vena cava positioning.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Observational StudyCharacteristics and long-term outcomes of contemporary patients with bicuspid aortic valves.
We sought to study the impact of surgical intervention on long-term outcomes in bicuspid aortic valve (BAV) patients who develop aortic valvular complications and/or have a concomitant aortopathy. ⋯ Patients with BAV have a high prevalence of AV dysfunction and concomitant aortopathy. Undergoing surgery (AV replacement and/or repair ± AAR) was associated with a significantly lower incidence of death and/or dissection.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
A complexity scoring system for degenerative mitral valve repair.
To develop a score to allow stratification of complexity in degenerative mitral valve repair. ⋯ Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Evaluation of robotic cardiac surgery simulation training: A randomized controlled trial.
To compare the currently available simulation training modalities used to teach robotic surgery. ⋯ We have completed the first randomized controlled trial to objectively compare the different training modalities of robotic surgery. Our data demonstrate the significant benefits of wet lab and virtual reality robotic simulation training and highlight key differences in current training methods. This study can help guide training programs in investing resources in cost-effective, high-yield simulation exercises.