The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2019
Randomized Controlled Trial Multicenter StudyAspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial.
Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. ⋯ In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.
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J. Thorac. Cardiovasc. Surg. · Feb 2019
Randomized Controlled Trial Multicenter StudyTranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial.
Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes. ⋯ In this trial of patients having coronary artery surgery, tranexamic acid did not affect death or severe disability through to 1 year after surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.
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J. Thorac. Cardiovasc. Surg. · Feb 2019
ReviewConducting high-quality research in cardiothoracic surgical education: Recommendations from the Thoracic Education Cooperative Group.
There is a clear need for improved quality of research publications in the area of cardiothoracic surgical education. With the goals of enhancing the power, rigor, and strength of educational investigations, the Thoracic Education Cooperative Group seeks to outline key concepts in successfully conducting such research. ⋯ Educational research can serve to enhance the practices and careers of current trainees, our scientific community, and thoracic surgical educators. To optimize the quality of such educational research, it is imperative that teachers, innovators, and contributors to academic scholarship in our field familiarize themselves with key steps in conducting educational studies.
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J. Thorac. Cardiovasc. Surg. · Feb 2019
Impact of patient-specific morphologies on sinus flow stasis in transcatheter aortic valve replacement: An in vitro study.
The goal of this study is to evaluate how sinus flow patterns after transcatheter aortic valve replacement in realistic representative patient roots vary. Sinus flow can affect transcatheter aortic valve operation and likely leaflet thrombosis occurrence due to stasis and poor washout. How the interaction between transcatheter aortic valve and representative patient aortic roots affects sinus hemodynamics is important to establish for future individualization of transcatheter aortic valve replacement therapy. ⋯ Sinus flow dynamics are highly sensitive to aortic root characteristics and transcatheter aortic valve aortic root interaction. Differences in sinus-flow washout and stasis regions between representative patient models may be reflected in different risks of leaflet thrombosis or valve degeneration.
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J. Thorac. Cardiovasc. Surg. · Feb 2019
Stent and leaflet stresses in 26-mm, third-generation, balloon-expandable transcatheter aortic valve.
Transcatheter aortic valve replacement has proven successful in treating intermediate-risk, high-risk, and inoperable patients with severe aortic stenosis. Third-generation, balloon-expandable transcatheter aortic valves were developed with an outer sealing skirt to reduce paravalvular leakage. As transcatheter aortic valve replacement use expands, long-term durability questions remain. Valve design influences durability, where regions of increased leaflet stress are vulnerable to early degeneration. However, third-generation transcatheter aortic valve stresses are unknown. Our goals were to determine the stent and leaflet stresses of third-generation, balloon-expandable transcatheter aortic valves. ⋯ Stress analysis of the 26-mm SAPIEN 3 valve using exact geometry from high-resolution scans demonstrated that peak stresses for both transcatheter aortic valve stent and leaflets were present at commissural tips where leaflets were attached. These regions would be most likely to initiate degeneration. The Dacron skirt had minimal effect on stresses on leaflets and stent.