The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Examining the impact of active clearance of chest drainage catheters on postoperative atrial fibrillation.
Postoperative atrial fibrillation (POAF) is one of the most frequent complications encountered after heart surgery, and significantly increases complications and mortality. An obstructed chest tube, leaving unevacuated blood around the heart and lungs, can lead to atrial inflammation, which can trigger POAF. The aim of this study was to assess the effectiveness of chest drainage incorporating an active tube clearance (ATC) system in reducing the rate of POAF. ⋯ The use of an ATC chest drainage protocol may be associated with reduced POAF. Our results suggest that efforts to maintain chest tube patency could be useful to reduce the incidence of POAF.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Fate of remnant sinuses of Valsalva in patients with bicuspid and trileaflet valves undergoing aortic valve, ascending aorta, and aortic arch replacement.
In patients presenting with aortic valvulopathy with concomitant ascending aortic aneurysm, surgical management of the sinus of Valsalva segment remains undefined, especially for moderately dilated aortic roots. In patients with this pathology undergoing aortic valve replacement with supracoronary ascending aorta replacement, we assessed the fate of the remnant preserved sinus of Valsalva segment stratified by aortic valve morphology and pathology. ⋯ In patients with nonaneurysmal sinuses of Valsalva undergoing aortic valve replacement with supracoronary ascending aorta replacement, the sinus segment can be preserved irrespective of the type of valvular pathology (aortic stenosis vs aortic insufficiency) or valvular morphology (bicuspid aortic valve vs tricuspid aortic valve). Aortic valve replacement with supracoronary ascending aorta replacement may have a stabilizing effect on the sinus segment over long-term follow-up in patients with tricuspid aortic valves or bicuspid aortic valves.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Comparative StudyHigh-risk cardiac surgery as an alternative to transplant or mechanical support in patients with end-stage heart failure.
Although the results of cardiac surgery in patients with poor left ventricular function have been widely published, the outcomes in patients with end-stage heart failure who meet criteria for advanced therapies are not well investigated. As access to transplantation and ventricular assist device therapy remains limited, we explored the possibility of conventional surgery as an alternative option for highly selected patients with end-stage heart failure. ⋯ Despite high perioperative risk, the midterm survival after conventional surgery in patients eligible for advanced therapies seems to be acceptable and may be an alternative option for highly selected patients with end-stage heart failure.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Prospective study of giant paraesophageal hernia repair with 1-year follow-up.
Evaluating giant paraesophageal hernia (GPEH) repair requires long-term follow-up. GPEH repair can have associated high recurrence rates, yet this incidence depends on how recurrence is defined. Our objective was to prospectively evaluate patients undergoing GPEH repair with 1-year follow-up. ⋯ GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at 1 year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and greater than 2 cm hernia recurrences. Longer follow-up and critical assessment of our results are needed to understand the true impact of this procedure and better inform perioperative decision making.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Observational StudyLong-term outcomes of extracorporeal membrane oxygenation support for postcardiotomy shock.
Extracorporeal membrane oxygenation (ECMO) is a widely used technique for treating postcardiotomy cardiogenic shock (PCS); however, no study has compared the long-term outcomes of patients who receive ECMO support for PCS with those of the general population post cardiac surgery. ⋯ Patients receiving ECMO for PCS had similar outcomes to those of the non-ECMO group after the first year of follow-up despite significantly poor outcomes during the in-hospital course.