The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Stented bovine jugular vein graft (Melody valve) for surgical mitral valve replacement in infants and children.
The options for mitral valve replacement in children with irreparable mitral valve disease have been limited to fixed-diameter prostheses that do not accommodate for somatic growth. We have modified an externally stented bovine jugular vein graft (Melody valve) for implantation in this cohort. Because it is not a fixed-diameter prosthesis, we hypothesized that the valve can be expanded in the catheterization laboratory as the child grows. ⋯ The Melody valve has demonstrated acceptable short-term function. Implantation techniques to prevent left ventricular outflow tract obstruction (suture fixation of the distal stent) and paravalvular leaks (the addition of a pericardial cuff) should be considered. The Melody valve can be percutaneously expanded as the child grows.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Hospitalization before surgery increases risk for postoperative infections.
Exposure to a health care facility before surgery may increase risk for postoperative infections. Our objectives were to (1) determine whether the prevalence of postoperative infections was higher among patients who were hospitalized before cardiac surgery, (2) identify risk factors for infection, and (3) evaluate in-hospital outcomes. ⋯ Although the risk of infection decreased over time, the relationship between exposure to a health care facility before surgical intervention and higher infection risk remained substantial. Further investigation into processes of care surrounding infection control is necessary to reduce postoperative infections and associated morbidity.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Does grafting of the left anterior descending artery with the in situ right internal thoracic artery have an impact on late outcomes in the context of bilateral internal thoracic artery usage?
Despite their well-established advantages, bilateral internal thoracic arteries (BITA) are still largely underused. This is partly because of the technical complexities associated with the use of the right internal thoracic artery (RITA) to guarantee the universally accepted gold standard left internal thoracic artery (LITA) to left anterior descending artery (LAD) graft. The use of the in situ RITA for LAD grafting is a less technically demanding strategy. The impact of this strategy on early and late outcomes is investigated in the context of BITA usage. ⋯ Using in situ BITA with retrosternal in situ RITA for LAD grafting is a technically less demanding, safe, and effective strategy that can increase usage of BITA by avoiding a composite graft configuration or technically challenging retrocaval routing of in situ RITA through the transverse sinus.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Reperfusion pulmonary edema in children with tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries undergoing unifocalization procedures: A pilot study examining potential pathophysiologic mechanisms and clinical significance.
Children with tetralogy of Fallot (TOF), pulmonary atresia (PA), and major aortopulmonary collateral arteries (MAPCAs) are at risk for reperfusion pulmonary edema (RPE) after unifocalization procedures to reconstruct the central pulmonary arteries. The purpose of this study was to determine the incidence of RPE, describe the clinical course of patients with RPE, and explore the mechanism of RPE in this population by measuring plasma biomarkers of alveolar epithelial and endothelial injury and lung inflammation. ⋯ Fifty percent of children with TOF/PA/MAPCAs undergoing unifocalization surgery developed RPE. Levels of plasma biomarkers of alveolar epithelial and endothelial injury and lung inflammation were not increased in patients with RPE compared with those without RPE. The presence of RPE did not affect the duration of respiratory failure and mechanical ventilation. The process of RPE is clinically self-limited and seems unlikely to be associated with vascular changes.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Minimally invasive mitral valve repair in Barlow's disease: early and long-term results.
Barlow's disease remains a challenging surgical pathology in patients presenting with mitral regurgitation. We reviewed our early and long-term results for patients with Barlow's disease who underwent minimally invasive mitral valve surgery. ⋯ A wide variety of repair techniques can be used to perform successful minimally invasive mitral valve repair in the majority of patients with Barlow's disease, with good early and long-term results.