The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Reoperation after early and late failure of mitral valve repair for degenerative disease.
To determine mechanisms of early and late failure after mitral valve repair for degenerative disease, identify factors associated with re-repair, and evaluate durability of re-repair. ⋯ Mitral valve re-repair can be performed with low rates of mortality and morbidity for early and late valve dysfunction. Mechanisms of early repair failure differ from those of late failure and are generally more amenable to re-repair. In selected patients who present after failed repair, we prefer mitral re-repair to valve replacement whenever technically feasible.
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Association between improved compliance with enhanced recovery after cardiac surgery guidelines and postoperative outcomes: A retrospective study.
Enhanced recovery after cardiac surgery is a multidisciplinary clinical care pathway that relies on a bundle of interventions, aiming to reduce the stress response to surgery and promote early recovery of organ function. In 2011, our institution introduced an institutional enhanced recovery after cardiac surgery program focusing on 9 central interventions, which have been expanded during the past decade by additional interventions now considered standard of care. After the recent publication of the enhanced recovery after cardiac surgery guidelines, we evaluated the relation between the compliance with these enhanced recovery after cardiac surgery guidelines and postoperative outcomes. ⋯ This audit revealed a correlation between increased compliance with enhanced recovery after cardiac surgery guidelines and a reduction of postoperative complications and hospital length of stay. Future trials are needed to establish evidence-based recommendations for each separate intervention of the enhanced recovery after cardiac surgery guidelines and to create a minimum core-set of enhanced recovery after cardiac surgery interventions.
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Early outcomes of the Y-incision technique to enlarge the aortic annulus 3 to 4 valve sizes.
To evaluate the safety and efficacy of a novel aortic annular enlargement technique. ⋯ Y-incision aortic annular enlargement was safe and effective for upsizing the aortic annulus by 3 to 4 valve sizes.
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Long-term Implantable Ventricular Assist Device Support in Children.
In pediatrics, implantable continuous-flow ventricular assist devices (IC-VAD) are often used as a "temporary" support, bridging children to cardiac transplantation during the same hospital admission. ⋯ This study suggests the feasibility of outpatient management of pediatric IC-VAD support. The ability to offer true long-term support maximizes the potential of IC-VAD support, not limited to a temporary bridging tool for heart transplantation.
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The American Association for Thoracic Surgery 2010 guidelines stipulate that rapid growth of the aorta (>3 mm/y) is an indication for prophylactic surgical intervention. Because of the many potential sources of error in aortic measurement (including measurement variability and comparison of noncorresponding segments), we explored whether rapid aortic growth was a reality or a falsehood. ⋯ Although not a falsehood, rapid growth is uncommon for the ascending and descending aorta. Many putative cases are reflective of measurement error. Attention to potential sources of measurement error is key. VIDEO ABSTRACT.