The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Comparative StudyResidual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis.
To identify and understand residual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis (IE), we categorized the intraoperative pathologic entities in patients with left-sided IE and correlated the pathology (noninvasive vs invasive) and organism with IE context (affected valve, native vs prosthetic [PVE]) and surgical results. ⋯ During the past decade, we have had low hospital mortality for surgically treated left-sided IE and have neutralized the added risk of PVE. However, outcomes remain worse for mitral versus aortic valve IE, with residual obstacles related to patient factors, inherent mitral valve anatomy in patients with invasive disease, and lack of an alternative mitral valve prosthesis optimal for IE.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Comparative StudyA minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay.
The Cox maze IV procedure has the best results for the surgical treatment of atrial fibrillation. It has been traditionally performed through sternotomy with excellent outcomes, but this has been considered to be too invasive. An alternative approach is to perform a less invasive right anterolateral minithoracotomy. This series compared these approaches at a single center in consecutive patients. ⋯ The Cox maze IV procedure performed through a right minithoracotomy is as effective as sternotomy in the treatment of atrial fibrillation. This approach was associated with fewer complications, decreased mortality and decreased length of stay in the intensive care unit and hospital length of stay.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Long-term outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma.
The management of acute type A aortic dissection complicated by coma remains controversial. We previously reported an excellent rate of recovery of consciousness provided aortic repair was performed within 5 hours of the onset of symptoms. This study evaluates the early and long-term outcomes using this approach. ⋯ The early and long-term outcomes as a result of immediate aortic repair for acute type A aortic dissection complicated by coma were satisfactory.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Modeling of predissection aortic size in acute type A dissection: More than 90% fail to meet the guidelines for elective ascending replacement.
The current guidelines for ascending aortic replacement were determined from already dissected aorta diameters. Previous computed tomography-based work on humans who underwent imaging before and directly after aortic dissection onset has shown an average 30% increase in the ascending aortic diameter with acute dissection. The present investigation evaluated the incidence of predissection ascending aortic dilatation in acute type A dissection. ⋯ More than 60% of patients with spontaneous, non-Marfan, nonbicuspid, type A dissection will have a nondilated ascending aorta before dissection onset. Only 3% would meet the criteria for elective ascending replacement to prevent aortic dissection. Additional research on the genetic and biochemical predictors of aortic dissection is essential.
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J. Thorac. Cardiovasc. Surg. · Sep 2014
Observational StudyAspirin unresponsiveness predicts thrombosis in high-risk pediatric patients after cardiac surgery.
Thrombosis occurs in up to 26% of patients with congenital heart disease after cardiac surgery and is associated with increased morbidity and mortality. Aspirin is commonly administered to reduce the risk of thrombosis, yet aspirin responsiveness is rarely assessed. In this study, we hypothesize that inadequate response to aspirin is associated with increased risk of thrombosis after selected congenital cardiac procedures considered to be high risk for thrombosis. ⋯ Postoperative thrombosis is associated with aspirin unresponsiveness in this patient population. In high-risk patients, monitoring of aspirin therapy and consideration of dose adjustment or alternative agents for unresponsive patients may be justified and warrants further investigation in a prospective trial.