The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2016
Time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI) analysis of hemodynamics in valve-sparing aortic root repair with an anatomically shaped sinus prosthesis.
The anatomically shaped sinus prosthesis (Uni-Graft W SINUS; Braun, Melsungen, Germany) used in valve-sparing aortic root replacement promises physiological hemodynamics believed to grant physiologic valve function. Using time-resolved 3-dimensional magnetic resonance phase contrast imaging (4D Flow MRI), we analyzed sinus vortex formation and transvalvular pressure gradients in patients with sinus prosthesis compared with age-matched and young healthy volunteers. ⋯ Hemodynamics closely relating to those of volunteers were confirmed in sinus prostheses, believed to grant physiological valve function. Minor differences are presumably attributed to graft compliance and temporal resolution of the acquisition. Nevertheless, long-term deterioration of valve function as it was described for straight grafts could potentially be decelerated using sinus prostheses.
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J. Thorac. Cardiovasc. Surg. · Aug 2016
Editorial ReviewTranscatheter mitral valve regurgitation treatment: State of the art and a glimpse to the future.
Since the first transcatheter heart valve implantation in the pulmonary position in 2000 and in the aortic position in 2002, a large number of transcatheter heart valves have reached the clinical arena and thousands of high-risk patients have been treated successfully, in particular those with severe aortic stenosis. In contrast, the experience of transcatheter mitral valve repair or implantation started relatively more recently, and only a few devices are available at the moment. The aim of this review is to describe the different percutaneous systems for the treatment of mitral regurgitation.
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J. Thorac. Cardiovasc. Surg. · Aug 2016
Pharmacokinetic characteristics and microbiologic appropriateness of cefazolin for perioperative antibiotic prophylaxis in elective cardiac surgery.
Adequate levels of perioperative antibiotic prophylaxis are essential for prevention of surgical site infections. We examined pharmacokinetic details of 2 g cefazolin administered during induction of anesthesia with repeat dosing shortly after initiation of cardiopulmonary bypass (CPB) in cardiac surgery. ⋯ Two grams of cefazolin at induction of anesthesia with a repeat dose after initiation of CPB ensures adequate drug levels to target a majority of pathogens of surgical site infections. Pharmacokinetic modeling demonstrated a significant influence of CPB on the volume of distribution and elimination of cefazolin. Other influences on pharmacokinetic parameters were albumin, protein, and creatinine clearance.
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J. Thorac. Cardiovasc. Surg. · Aug 2016
Routine venous thromboembolism screening after pneumonectomy: The more you look, the more you see.
Symptomatic venous thromboembolism (VTE) after pneumonectomy is associated with poor prognosis. We describe a new care pathway for patients undergoing pneumonectomy in which asymptomatic lower-extremity VTE screening was performed to determine if it increases VTE detection and potentially decreases sequelae. ⋯ Prevalence of VTE after pneumonectomy is higher than previously thought. The risk of developing a VTE peaks at 6 days after pneumonectomy, and remains increased until 30 days, suggesting a need for additional screening or longer prophylaxis.