The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Simulating hemodynamics of the Fontan Y-graft based on patient-specific in vivo connections.
Using a bifurcated Y-graft as the Fontan baffle is hypothesized to streamline and improve flow dynamics through the total cavopulmonary connection (TCPC). This study conducted numerical simulations to evaluate this hypothesis using postoperative data from 5 patients. ⋯ Five consecutive patients received a Y-graft connection to complete their Fontan procedure with positive hemodynamic results. Refining the surgical technique for implementation should result in further energetic improvements that may help improve long-term outcomes.
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Aneurysmal diseases are often silent but can cause potentially life-threatening complications in cases of dissection or rupture. Surgical strategies depend on the involved part of the aorta and frequently require extracorporeal circulation and circulatory arrest. ⋯ These include the conventional elephant trunk procedure introduced by Hans Borst in 1983, with several modifications, and also hybrid procedures combining open surgical and endovascular techniques: the so-called frozen elephant trunk. Advantages and drawbacks of both techniques will be discussed based on personal and practical perspectives, with specific mention of the elephant trunk procedure in acute aortic dissections.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Elective femoro-femoral cardiopulmonary bypass during transcatheter aortic valve implantation: a useful tool.
Transcatheter aortic valve implantation is a new method to treat high-risk patients with aortic valve stenosis. The operative risk can be reduced, especially in patients with severely reduced left ventricular function or cardiogenic shock. Nevertheless, this new procedure has some potential risks, especially during the phases of rapid pacing (valvuloplasty and valve deployment). The use of cardiopulmonary bypass allows the perioperative risk to be reduced. ⋯ The use of cardiopulmonary bypass enhances safety in critical transcatheter aortic valve implantation procedures. Furthermore, transcatheter aortic valve implantation with cardiopulmonary bypass seems to provide better results than medical therapy or conventional aortic valve replacement in critically ill patients. The need for cardiopulmonary bypass emphasizes that the procedure should be performed only in cooperation between cardiologists and cardiac surgeons.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Randomized Controlled TrialInspiratory muscle training for diaphragm dysfunction after cardiac surgery.
Diaphragm dysfunction is a complication of cardiac surgery with partial or absent spontaneous recovery in most cases. Surgical diaphragm plication represents the only option when symptoms persist. Because training improves functional nerve recovery after a nerve lesion, we hypothesized that early diaphragm muscle training may be beneficial. ⋯ Inspiratory muscle training may improve inspiratory muscle strength and increases paralyzed diaphragm mobility.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Multicenter StudyComplete but not partial thymectomy in early infancy reduces T-cell-mediated immune response: three-year tracing study after pediatric cardiac surgery.
Thymectomy is often performed to secure an operative field in surgery for congenital heart defects in early infancy. However, how neonatal thymectomy affects the subsequent development of the immune system in humans remains unclear. We monitored patients for 3 years from the time of thymectomy that was performed during cardiac surgery in early infancy. ⋯ The results revealed that complete thymectomy in early infancy reduces the number of circulating T cells and T-cell-mediated immune responses for at least 3 years, suggesting that the thymus should be at least partially preserved during surgery in early infancy to maintain protective immunity.