The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Conduction disturbance after isolated surgical aortic valve replacement in degenerative aortic stenosis.
Conduction disturbances are common in patients with aortic stenosis. We investigated the incidence, reversibility, and prognosis of conduction disorders requiring permanent pacemaker implantation in patients with degenerative aortic stenosis after isolated aortic valve replacement. ⋯ After isolated aortic valve replacement, permanent pacemaker implantation for conduction disturbance is rare (n = 10/663, 1.5%). Isolated aortic valve replacement for degenerative aortic stenosis has a low risk of conduction disturbances during long-term follow-up.
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Adrenergic receptor genotypes influence postoperative outcomes in infants in the Single-Ventricle Reconstruction Trial.
Adrenergic receptor (ADR) genotypes have been associated with adverse outcomes in heart failure. Our objective was to evaluate the association of ADR genotypes with post-Norwood outcomes in infants with hypoplastic left heart syndrome (HLHS). ⋯ Infants with HLHS harboring ADR genotypes that are associated with greater catecholamine release or sensitivity had lower event-free survival after staged palliation. Excess catecholamine activation may adversely affect cardiovascular adaptation after the Norwood procedure. Future studies should explore whether targeting adrenergic activation in those harboring risk genotypes can improve outcomes. (ClinicalTrials.gov number NCT00115934).
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J. Thorac. Cardiovasc. Surg. · Nov 2017
CommentYoung infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation.
Infants with severe tetralogy of Fallot may undergo (1) early primary surgical repair (EARLY) or (2) early transcatheter palliation (CATH) before delayed surgical repair. We compared these strategies with (3) elective single-stage tetralogy of Fallot repair (IDEAL). ⋯ Early primary repair for neonates may increase surgical reoperation, whereas transcatheter palliation comes at a cost of increased catheter reintervention. However, overall outcomes between groups, in terms of survival, growth, and hemodynamic parameters, were comparable, suggesting that both strategies are a reasonable option for children with severe tetralogy of Fallot.
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years.
To address the long-term durability of bioprostheses used for aortic valve replacement (AVR) in adult patients aged ≤60 years at the time of surgery. ⋯ The lifetime risk of SVD is considerable in patients aged ≤60 years at the time of bioprosthesis implantation. Nonetheless, durability remains consistent during the first decade; additional data are required for the second decade. Patients' information is pivotal for valve choice (competing-risks method).
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring.
We sought to define the lower and upper limits of cerebral blood flow autoregulation and the optimal blood pressure during cardiopulmonary bypass. We further sought to identify variables predictive of these autoregulation end points. ⋯ Real-time monitoring of autoregulation may improve individualizing mean arterial pressure during cardiopulmonary bypass and improving patient outcomes.