The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Comparative StudyRight ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants.
To assess the outcomes following primary tetralogy of Fallot (TOF) repair in neonates and young infants with pulmonary stenosis (PS) and pulmonary atresia and compare differences in reintervention on the right ventricular outflow tract (RVOT) among those undergoing valve sparing repair (VSR), transannular RVOT patch (TAP), and right ventricle-to-pulmonary artery (RV-PA) conduit surgeries. ⋯ Neonatal TOF repair can be performed with low mortality but frequent RVOT reinterventions. Surgical reintervention is earlier and the rate is higher among patients with TOF/PA undergoing RV-PA conduit repair compared with those undergoing TAP. Although there were no overall differences in RVOT reintervention rate between patients with TOF/PS undergoing VSR and those undergoing TAP, a lower birth weight in the patients undergoing VSR is associated with a higher surgical reintervention rate.
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Multicenter Study Comparative Study WebcastsBioprosthetic aortic valve replacement: Revisiting prosthesis choice in patients younger than 50 years old.
Aortic prosthesis choice is controversial in young adults because robust comparative outcome data are lacking. We therefore compared mortality and morbidity in young adults after bioprosthetic versus mechanical aortic valve replacement. ⋯ Although lifetime risks are represented incompletely, these findings suggest that in adults aged 18-50 years, bioprostheses are a reasonable alternative to mechanical valves for aortic valve replacement.
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Multicenter StudyA multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis.
The incidence and severity of Clostridium difficile infection (CDI) have increased rapidly over the past 2 decades, particularly in elderly patients with multiple comorbidities. This study sought to characterize the incidence and risks of these infections in cardiac surgery patients. ⋯ In this large multicenter prospective study of major infections following cardiac surgery, CDI was encountered in nearly 1% of patients, was frequently diagnosed postdischarge, and was associated with extended length of stay and substantially increased mortality. Patients with comorbidities, longer surgery time, extended antibiotic exposure, and/or hyperglycemic episodes were at increased risk for CDI.
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Comparative StudyAn interactive simulation tool for patient-specific clinical decision support in single-ventricle physiology.
Modeling of single-ventricle circulations has yielded important insights into their unique flow dynamics and physiology. Here we translated a state-of-the-art mathematical model into a patient-specific clinical decision support interactive Web-based simulation tool and show validation for all 3 stages of single-ventricular palliation. ⋯ This simulator responds quickly and predicts patient-specific hemodynamics with good clinical accuracy. By predicting postoperative and postintervention hemodynamics in all 3 stages of single-ventricle physiology, the simulator could assist in clinical decision-making, training, and consultation. Continuing model refinement and validation will further its application to the bedside.