The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Long-term survival after composite mechanical aortic root replacement: a consecutive series of 448 cases.
To determine the effect of different etiologies on the outcome and mortality after mechanical composite aortic root/ascending replacement. ⋯ Composite root replacement remains a versatile choice for various pathologic features with excellent longevity and freedom from reoperation and should be strongly considered if conditions for valve-sparing repair are less than perfect.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Multicenter StudyComprehensive surgical approach to treat atrial fibrillation in patients with variant pulmonary venous anatomy.
Catheter radiofrequency ablation procedures yield fairly successful results for the treatment of atrial fibrillation; however, patients with anatomic variant pulmonary veins (PV) are generally thought not to benefit from catheter ablation technique, with recurrence rates observed as high as 78%. We report a comprehensive surgical approach to treat this subset of patients with a modified full maze procedure. ⋯ A modified full maze procedure should be considered as a first choice treatment for atrial fibrillation with variant drainage of PVs because of the nature of PV size, wall thickness, and specific foci in the arrhythmogenic veins. Multiple PV isolation and epicardial-endocardial longitudinal PV ablations along with the standard maze are essential to success. Early referral for surgical ablation allows higher success rates.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease.
The durability of valve-sparing aortic root replacement with or without cusp repair in patients with bicuspid aortic valve (BAV) disease is questioned. We analyzed the results of 75 patients with a BAV undergoing Tirone David reimplantation valve-sparing aortic root replacement. ⋯ After David procedure and cusp repair in patients with a BAV, midterm clinical and valve function outcomes were favorable out to 6 years. More follow-up is required to determine long-term valve durability and the hazard of other clinically important late adverse events, including eventual reoperation, to beyond 10 years.
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Percutaneous transcatheter aortic valve replacement was introduced in 2002, but its effectiveness remained to be assessed. ⋯ The PARTNER A and B trials showed that survival has been remarkably good, but stroke and perivalvular leakage require further device development.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Meta AnalysisDrug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of early outcomes from randomized and nonrandomized studies.
The present meta-analysis aimed to compare the short-term safety and efficacy of drug-eluting stents and coronary artery bypass graft surgery for patients with left main coronary artery disease. ⋯ Patients treated by drug-eluting stents in randomized controlled trials and observational studies in the current literature are often a preselected subgroup with less complex lesions compared with the overall target population. Results drawn from these studies should be viewed with caution. Coronary artery bypass grafting is associated with a lower incidence of major adverse cardiac and cerebrovascular events at 1 year and beyond, and thus should be regarded as the standard of treatment. However, drug-eluting stents may have a role for selected patients with percutaneously amenable left main disease who are poor surgical candidates.