The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Randomized Controlled Trial Comparative StudyAntiplatelet effects of ticagrelor versus clopidogrel after coronary artery bypass graft surgery: A single-center randomized controlled trial.
The study objective was to compare the onset of platelet inhibition (inhibition of platelet aggregation) between ticagrelor 90 mg twice per day and clopidogrel 75 mg once per day in patients receiving coronary artery bypass grafting. ⋯ In patients receiving coronary artery bypass grafting, the onset of action was faster and the peak inhibition of platelet aggregation was higher with ticagrelor than with clopidogrel.
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Long-term clinical outcome and graft patency of radial artery and saphenous vein grafts in multiple arterial revascularization.
The long-term benefits of multiple arterial revascularization (MAR) in coronary artery bypass grafting remain uncertain. The aim of this study was to investigate the clinical outcome, graft patency, and need for subsequent target revascularization of radial artery (RA) versus saphenous vein graft in patients undergoing MAR in both patient- and graft-specific analyses. ⋯ MAR with BITA and RA grafting revealed to be the recommended strategy in coronary artery bypass grafting to achieve long-term beneficial results. The use of saphenous vein graft showed less favorable outcomes regarding patency and the need for target-vessel revascularization.
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Ventricular interactions and electromechanical dyssynchrony after Ross and Ross-Konno operations.
Ross and Ross-Konno operations are associated with the inherent risk of residual ventricular septal dysfunction and injury to the conduction system. However, comprehensive biventricular functional outcomes on magnetic resonance imaging after Ross and Ross-Konno procedures are unknown. The purpose of this study was to evaluate and compare the degree of electrical and mechanical dyssynchrony using cardiac magnetic resonance imaging in patients late after Ross and Ross-Konno operations. ⋯ Long-term follow-up of patients who underwent Ross and Ross-Konno operations demonstrates reduced LV global longitudinal strain suggestive of chronically increased afterload independent of autograft function. Additionally, Ross-Konno operation is associated with impaired LV intraventricular mechanics and electrical dyssynchrony.
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Lung cancer is a leading cause of cancer death and in suitable cases the best chance of cure is offered by surgery. Lung resection is associated with significant postoperative cardiorespiratory morbidity, with dyspnea and reduced functional capacity as dominant features. These changes are poorly associated with deterioration in pulmonary function and a potential role of right ventricular (RV) dysfunction has been hypothesized. Cardiovascular magnetic resonance imaging is a reference method for noninvasive assessment of RV function and has not previously been applied to this population. ⋯ These findings suggest RV dysfunction occurs following lung resection and persists 2 months after surgery. The deterioration in the ratio of stroke volume to end systolic volume suggests a mismatch between afterload and contractility. There is an increase in indices of pulsatile afterload resulting from the operative pulmonary artery.