The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2018
Randomized Controlled Trial Comparative StudySaphenous vein versus right internal thoracic artery as a Y-composite graft: Five-year angiographic and clinical results of a randomized trial.
We compared the 5-year graft occlusion rates and midterm clinical outcomes of saphenous vein composite grafts with those of right internal thoracic artery composite grafts in patients who were enrolled in the SAphenous VEin versus Right Internal Thoracic Artery as a Y-Composite Graft trial. ⋯ The saphenous vein composite grafts were noninferior to the right internal thoracic artery composite grafts in terms of 5-year graft occlusion rates and midterm clinical outcomes.
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J. Thorac. Cardiovasc. Surg. · Oct 2018
Comparative StudyNationwide cohort study of mitral valve repair versus replacement for infective endocarditis.
The feasibility and long-term outcomes of mitral valve (MV) repair in patients with infective endocarditis (IE) remain unclear. ⋯ Mitral repair for IE has better perioperative and late outcomes than mitral replacement. Mitral repair performed by an experienced team is recommended for IE patients instead of MV replacement whenever possible, even with an active infection status.
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J. Thorac. Cardiovasc. Surg. · Oct 2018
Comparative Study Observational StudyModification of expanded polytetrafluoroethylene valved conduit using the thin-type leaflets.
The expanded polytetrafluoroethylene conduit with fan-shaped leaflets and bulging sinuses for right ventricular outflow tract reconstruction was modified with a newly developed thin-type expanded polytetrafluoroethylene leaflet. The purpose of this study was to evaluate the clinical outcomes and hemodynamic performance of the modified conduit. ⋯ Although the clinical outcomes did not differ within midterm observation, the thin-type expanded polytetrafluoroethylene leaflet was considered to be suitable for the small-sized conduits, but not for large-sized conduits, based on the comparison of the hemodynamic performance. Long-term follow-up is necessary to address the appropriate sheet type for middle-sized conduits and to estimate the durability of the thin-type leaflet.
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J. Thorac. Cardiovasc. Surg. · Oct 2018
Postoperative atrial fibrillation is associated with increased morbidity and resource utilization after left ventricular assist device placement.
Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality after cardiac surgery but has not been investigated in the left ventricular assist device (LVAD) population. We hypothesize that POAF will increase morbidity and resource utilization after LVAD placement. ⋯ POAF was associated with increased major morbidity, possibly from worsening right heart failure leading to increased renal failure and unplanned right ventricular assist device placement. This led to patients with POAF having longer intensive care unit and hospital stays and more frequent discharges to a facility.
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J. Thorac. Cardiovasc. Surg. · Oct 2018
Conventional redo biological valve replacement over 20 years: Surgical benchmarks should guide patient selection for transcatheter valve-in-valve therapy.
Although primary transcatheter valve interventions have demonstrated acceptable early- and intermediate-term outcomes, data are lacking to guide patient selection for transcatheter valve-in-valve therapy. Furthermore, very few surgical benchmarks have been established for repeat conventional biological valve replacement to refine momentum for broad application of transcatheter intervention for a degenerated bioprosthesis. ⋯ In a large population of patients undergoing repeat biological valve replacement, prior coronary bypass grafting and advanced New York Heart Association functional class were associated with increased 30-day mortality, with the remaining population having a low 30-day mortality of 4%. This study could serve as a surgical benchmark to guide patient selection for transcatheter valve-in-valve technology rather than employing a broader application of these techniques to those who may otherwise have low early risk of mortality and durable long-term survival after conventional valve surgery.