The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Long-Term Enlargement of the Neo-Aortic Root and Aortic Arch Following Arch Reconstruction in Hypoplastic Left Heart Syndrome.
Long-term enlargement of the aortic arch after aortic arch reconstruction in hypoplastic left heart syndrome is not well described. ⋯ Neo-aortic root and aortic arch in hypoplastic left heart syndrome are enlarged early after aortic arch reconstruction and continue to enlarge out of proportion to normal controls until 12 months of age, with gradual decline in enlargement up to adolescence. Further work should focus on modifiable surgical factors that may prove important to optimize arch growth and geometry.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
The Intra-Aortic Balloon Pump as a Rescue Device: Do we need to shift our strategy for cardiogenic shock rescue after cardiac surgery?
The intra-aortic balloon pump (IABP) is widely used to rescue patients from complications following cardiac surgery. Given improvements in rescue strategies over the past decade, the appropriateness of IABP must be reexamined. This study assessed the risk factors, outcomes, and predictors of survival of rescue IABP placement. ⋯ Rescue IABP following cardiac surgery is associated with increased early and 1-year mortality. Prolonged IABP use beyond 4 days or cardiac arrest as an indication portended a significantly worse prognosis. Rescue IABP may not be the optimal first-line temporary MCS for all patients, as the level of support provided might not match the severity of cardiogenic shock. Alternative MCS strategies should be considered early.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Impact of the Grade and Jet-flow Direction of Residual Aortic Regurgitation after Valve-Sparing Root Replacement.
To investigate the impact of the grade and jet direction of residual aortic regurgitation (rAR) after valve-sparing root replacement (VSRR). ⋯ rAR after VSRR operation could be a risk factor for AR progression. Minimal central rAR generally has a tolerable clinical course; however, patients with even minimal eccentric AR may develop AR progression, so active surveillance and timely management might be required. Furthermore, early VSRR can help reduce the rAR.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Postoperative Aortic Isthmus Size After Arch Reconstruction with Patch Augmentation Predicts Arch Reintervention.
Reintervention rates after patch-augmented reconstruction for hypoplastic aortic arch remain moderately high. We analyzed mid-term outcomes of aortic arch reconstruction to define modifiable reintervention risk factors. ⋯ Aortic undersizing during patch-augmented reconstruction of hypoplastic aortic arch results in over 10% rate of reintervention at mid-term follow-up. Achieving adequate postoperative arch size is critical for preventing reintervention, with aortic isthmus size being of utmost importance.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Clinical Effectiveness of Genetic Testing Guidelines in Patients with Thoracic Aortic Aneurysms.
To analyze the effectiveness of the current genetic testing guidelines for patients with thoracic aortic aneurysms. ⋯ Refining genetic testing guidelines to incorporate multiple patient criteria could enhance risk stratification and support informed decision-making in genetic testing for TAD. Limiting testing to genes strongly associated with TAD could lower VUS rates.