The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis: A 12-year experience in high-risk patients.
We examined the early and midterm outcomes of homograft use in reoperative aortic root and proximal aortic surgery for endocarditis and estimated the associated risk of postoperative reinfection. ⋯ This is one of the largest North American single-center series of homograft use in reoperations on the proximal thoracic aorta to treat active endocarditis. In this high-risk population, homograft tissue can be used with acceptable early and midterm survival and a low risk of reinfection. When necessary, homograft tissue may be extended into the distal ascending and transverse aortic arch, with excellent results. These patients require long-term surveillance for both infection and implant durability.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Multicenter Study Comparative Study Observational StudyMitral valve repair rates correlate with surgeon and institutional experience.
Mitral valve (MV) repair rates have lagged despite reported superior outcomes in patients with mitral regurgitation. The purpose of the present study was to evaluate the relationship between procedure volume and the propensity for MV repair in a multi-institution, regional patient cohort. ⋯ Significant variation in the performance of MV repair over MVR for mitral regurgitation persists in the modern surgical era. Average annual surgeon volume was more significantly associated with MV repair rate than institutional volume, with an increased likelihood for performance of MV repair among surgeons performing >20 procedures annually. In the upcoming era of percutaneous MV repair, surgeon volume and expertise as a gatekeeper should dictate access to this technology and the decisions for the best approach to MV repair.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Multicenter StudyWhen does transapical aortic valve replacement become a futile procedure? An analysis from a national registry.
Patient selection is crucial to achieve good outcomes and to avoid futile procedures in patients undergoing transcatheter aortic valve replacement. The aim of this multicenter retrospective study was to identify independent predictors of 1-year mortality in patients surviving after transapical transcatheter aortic valve replacement. ⋯ According to our data, among patients undergoing transapical transcatheter aortic valve replacement, those with insulin-dependent diabetes, advanced chronic kidney disease, rhythm disorders, and low left ventricular ejection fraction have a higher risk to undergo futile procedures.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Multicenter StudyEarly and intermediate outcome after aortic valve replacement with a sutureless bioprosthesis: Results of a multicenter study.
The aim of this study was to evaluate the outcome of aortic valve replacement with the sutureless Perceval S aortic valve bioprosthesis (Sorin Biomedica Cardio Srl, Saluggia, Italy). ⋯ The sutureless Perceval S valve is associated with excellent early survival in high-risk patients, particularly among those undergoing an isolated procedure. Further studies are needed to prove the durability of this bioprosthesis.