The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Differential effects of atorvastatin on autophagy in ischemic and nonischemic myocardium in Ossabaw swine with metabolic syndrome.
The perioperative administration of pleomorphic statin drugs has been implicated in improving outcomes after cardiac surgery. Adaptive autophagy is a highly conserved cellular process that allows for the elimination of dysfunctional cell components in response to stress and survival under starving conditions. We sought to investigate the effects of the statin drug atorvastatin on autophagy in ischemic and nonischemic myocardia using a clinically relevant porcine model of metabolic syndrome. ⋯ Atorvastatin administration has differential effects on autophagy in ischemic and nonischemic myocardia. In the setting of metabolic syndrome, atorvastatin stimulates autophagy in nonischemic myocardium while partly inhibiting autophagy in ischemic myocardium. The differential regulation on autophagy may, in part, explain the cardioprotective effect of statins in both ischemic and nonischemic myocardia, and these findings may have implications in the setting of cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Multicenter StudyResults of type II hybrid arch repair with zone 0 stent graft deployment for complex aortic arch pathology.
To review the early results of a less invasive, single-stage hybrid arch procedure involving replacement of the ascending aorta, arch debranching, and zone 0 antegrade stent graft deployment. ⋯ This single-stage hybrid arch procedure offers an alternative approach to complex diffuse aortic pathology involving the arch. Replacement of the ascending aorta provides a safe location for zone 0 stent graft deployment, eliminating complications of proximal deployment in a native diseased aorta.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative StudyThe CarboMedics supra-annular Top Hat valve improves long-term left ventricular mass regression.
The present study aimed to identify potential differences in hemodynamic performance between the supra-annular CarboMedics Top Hat valve and the intra-annular CarboMedics standard valve in terms of the long-term left ventricular mass reduction and transvalvular gradients. ⋯ The Top Hat valve surpasses hemodynamically the intra-annular valve. We suggest the supra-annular Top Hat prosthesis can be especially recommended for patients with a small aortic root and severe myocardial hypertrophy.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
ReviewRight ventricular architecture responsible for mechanical performance: unifying role of ventricular septum.
The right ventricle (RV) is composed of a free wall containing a wrap-around circumferential muscle at its base and a septum composed of helical fibers that are oblique and cross each other at 60° angles. This structure is defined by the helical ventricular myocardial band and defines RV function because the wrap-around transverse fibers constrict or compress to cause the bellows motion responsible for 20% of RV output, whereas the oblique fibers determine shortening and lengthening that produces 80% of RV systolic function. Clinical shortening is quantified by tricuspid annular plane systolic excursion and measured by echocardiography. ⋯ Conversely, septal damage causes RV dysfunction if pulmonary vascular resistance is increased. The interaction between structure and function to cause RV failure and how these factors become corrected is defined for RV failure, RV relationship to LV failure, resynchronization, pacing, RV dysplasia, left ventricular assist device, intraoperative septal injury during myocardial protection, the septal role in tricuspid insufficiency, pharmacologic decisions on altering pulmonary vascular resistance in RV failure, congenital heart disease, and adult heart disease is considered in this overview. These structure-function relationships emphasize why clinical decisions must be based on knowledge of normality, recognizing how disease offsets normality, and introducing actions that rebuild normality.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Skeletal muscle and plasma concentrations of cefazolin during cardiac surgery in infants.
To describe the pharmacokinetics and tissue disposition of prophylactic cefazolin into skeletal muscle in a pediatric population undergoing cardiac surgery. ⋯ This cefazolin dosing strategy resulted in skeletal muscle concentrations that are likely not effective for surgical prophylaxis against gram-negative pathogens but are effective against methicillin-sensitive S aureus in infants undergoing cardiac surgery.