The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Analysis of risk factors for recurrence after video-assisted pulmonary vein isolation of lone atrial fibrillation--results of 5 years of follow-up.
The purpose of the present study was to assess the efficacy of the long-term results after video-assisted pulmonary vein isolation and left atrial appendage excision for lone atrial fibrillation (AF) and to determine the most significant risk factors for the long-term results. ⋯ Patients with lone AF with a large preoperative left atrial diameter and long AF duration will not be suitable for video-assisted pulmonary vein isolation alone and might need to undergo ablation of the lesions.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
In situ total aortic arch replacement for infected distal aortic arch aneurysms with penetrating atherosclerotic ulcer.
We present a series of patients who underwent in situ total aortic arch replacement for infected distal aortic arch aneurysms. ⋯ Surgical treatment with the combination of radical debridement with in situ total aortic arch replacement using antegrade selective cerebral perfusion and omental flap grafting was a reliable procedure for the treatment of infected distal aortic arch aneurysms.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Combined endovascular and surgical approach for aortobronchial fistula.
The perioperative outcomes of the endovascular approach to aortobronchial fistula have been favorable. However, it is uncertain whether thoracic endovascular aneurysm repair (TEVAR) alone provides a complete and durable cure for an aortobronchial fistula. TEVAR does nothing to address the issue of the defect in the respiratory tract, leaving the patient at risk of aortobronchial fistula recurrence and/or stent graft infection. The authors believe that the bronchial defect should be addressed. ⋯ Emergency TEVAR for an aortobronchial fistula is an appealing strategy for this devastating complication. However, to achieve a lasting result, direct contact between the stent graft and the pulmonary tissue should be avoided to prevent further erosive damage. Concomitant or staged repair should entail primary repair or resection and anastomosis of the bronchus and/or pulmonary resection with coverage of the stent graft using muscle or pleural flaps combined with broad-spectrum intravenous antibiotic therapy. Long-term surveillance and continued investigation are warranted.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Toward individualized management of the ascending aorta in bicuspid aortic valve surgery: the role of valve phenotype in 1362 patients.
Decision making regarding the management of the ascending aorta (AA) in patients with a bicuspid aortic valve (BAV) undergoing valve surgery has hardly been individualized and remains controversial. We analyzed our individualized, multifactorial approach, focusing on the BAV phenotype. ⋯ The individualized, multifactorial management of AA in patients with BAV during aortic valve surgery leads to excellent results. The threshold AA diameter for intervention (AoP or AAR) varied from 34 to 51 mm (mean, 43.9). BAV type 2/unicuspid and BAV type 1 LR with regurgitation emerged as determinants for more liberal AAR in our practice. Longer term follow-up is necessary to confirm our conclusions.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Nature of the underlying heart disease affects survival in pediatric patients undergoing extracorporeal cardiopulmonary resuscitation.
To describe the use of extracorporeal membrane oxygenation (ECMO) in acute resuscitation after cardiac arrest in pediatric patients with heart disease, with reference to patient selection and predictors of outcome. ⋯ ECPR was associated with modest survival in pediatric patients with heart disease; however, this was associated in part with the underlying disease and pre-existing comorbidities, including the presence of acute kidney injury.