The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Primary graft dysfunction does not lead to increased cardiac allograft vasculopathy in surviving patients.
Early injury is associated with the development of cardiac allograft vasculopathy in heart transplantation. We examined whether adult heart transplant recipients surviving primary graft dysfunction were more susceptible to the development of cardiac allograft vasculopathy than their nonprimary graft dysfunction counterparts. ⋯ Primary graft dysfunction was associated with lower 30-day, 1-year, and 5-year allograft survival rates. Surviving patients, however, did not show increased tendency toward cardiac allograft vasculopathy development.
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The technical details of total arch replacement using antegrade cerebral perfusion are presented. ⋯ Our current approach for total aortic arch replacement is associated with low hospital mortality and morbidity, thus leading to a favorable long-term outcome.
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During the past 15 years, important advances in the field of aortic valve repair have transformed it from an infrequent and anecdotal exercise to a feasible and attractive alternative to valve replacement in selected patients with pure aortic insufficiency. These advances include a deeper understanding of the functional anatomy of the aortic valve and pathophysiologic mechanisms of aortic insufficiency; the development of surgical techniques to restore normal geometry to the aortic root and to restore the cusp coaptation; and the development of a common terminology that can be used by all clinicians to describe the lesions, discuss repair techniques, and compare immediate and long-term outcomes after aortic valve repair. This article attempts to describe the important principles of aortic valve repair by focusing on functional anatomy, surgical techniques for cusp repair, and outcome. By analogy with mitral valve repair, we include in the term aortic valve repair not only the repair of the cusp but also the valve-sparing root replacement or any kind of functional aortic annulus stabilization.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
"Corkscrew stenosis": defining and preventing a complication of percutaneous dilatational tracheostomy.
The short-term safety of percutaneous dilatational tracheostomy has been widely demonstrated. However, less is known about their long-term complications. Through an illustrative case series, we present and define "corkscrew stenosis," a type of tracheal stenosis uniquely associated with percutaneous dilatational tracheostomy. ⋯ We suggest that a unique form of tracheal stenosis can result from percutaneous dilatational tracheostomy. We observed corkscrew stenosis to be located proximally, associated with fractured tracheal rings, and morphologically appearing as interdigitation of these fractured rings. Recognizing corkscrew stenosis, its unique mechanism of formation, and technical means of prevention may be important in advancing the long-term safety of this procedure for critically ill patients who require prolonged ventilatory support.