The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Multicenter StudyA multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device.
The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. ⋯ Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
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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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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.
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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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J. Thorac. Cardiovasc. Surg. · Apr 2024
Outcomes of neo-aortic valve and root surgery late after arterial switch operation.
Neo-aortic root dilatation and valve regurgitation are emerging problems late after arterial switch operation (ASO). We sought to evaluate the prevalence and outcomes of neo-aortic root or valve reoperation after ASO. ⋯ The need for neo-aortic valve or root reoperation surpasses 10% by 30 years post-ASO. Evolving understanding of the mechanisms of neo-aortic valve insufficiency and techniques of neo-aortic valve repair may decrease the need for AVR.