The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Causes and management of aortic valve regurgitation after aortic valve reimplantation.
Recurrent aortic regurgitation can occur after valve-preserving aortic replacement. Little is known about the exact mechanisms of valve failure and the best reoperative strategies. We analyzed our experience with reoperation after aortic valve reimplantation. ⋯ Recurrent aortic regurgitation early after aortic valve reimplantation frequently involves cusp prolapse and a low commissural height; later, cusp retraction becomes more important. Reoperation within the first 6 postoperative months allows for preservation of the native aortic valve; however, beyond this period, valve replacement within the graft will mostly be required.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Early results with annular support in reconstruction of the bicuspid aortic valve.
Repair of the bicuspid aortic valve may be performed in aortic regurgitation and aneurysm. Dilatation of the atrioventricular junction has been identified as a risk factor for repair failure, and we have used suture annuloplasty to correct atrioventricular junction enlargement. The objective was to compare the early results of aortic repair with and without annuloplasty. ⋯ Preservation of the bicuspid aortic valve is feasible in many patients. Long-term stability of the repaired valves is good; the negative impact of a dilated atrioventricular junction can be reduced by suture annuloplasty.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Transcatheter aortic valve implantation: the European experience.
The European transcatheter aortic valve implantation experience began in 2002, and ever since, numerous centers have started a program, resulting in a "transcatheter aortic valve implantation pandemic." Considerable experience has been gained with various access routes for implantation and with valve-in-surgical bioprosthetic valve procedures. Reimbursement differs among the European countries and is currently undergoing rapid changes. Accordingly, the implantation rates in various European countries still differ considerably, with the greatest in Switzerland and Germany: 77 implants per 1 million treatable inhabitants. ⋯ The preliminary results from national European registries have been remarkably comparable in terms of survival and stroke. The "glimpse into the future" points toward implantation in intermediate-risk patients in contrast to high-risk or inoperable patients. The results of the Medtronic Surgical Replacement and Transcatheter Aortic Valve Implantation and Edwards Placement of Aortic Transcatheter Valves Trial 2 trials will show whether this change in paradigm is justified.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Immunohistochemical studies of pulmonary large cell neuroendocrine carcinoma: a possible association between staining patterns with neuroendocrine markers and tumor response to chemotherapy.
Pulmonary large cell neuroendocrine carcinoma is a rare high-grade malignant tumor. Because large cell neuroendocrine carcinoma is rare, the optimal treatment, including perioperative chemotherapy, has not been defined. We retrospectively analyzed the correlation among the effectiveness of perioperative chemotherapy in treating large cell neuroendocrine carcinoma, pathologic stage, and immunoreactivity to neuroendocrine markers. ⋯ Our results suggest that perioperative chemotherapy might benefit the survival of patients with pulmonary large cell neuroendocrine carcinoma, in particular when the tumors are not immunoreactive to all 3 neuroendocrine markers.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes.
The combined open surgical and endovascular approach for the treatment of aortic arch aneurysms has emerged as a safe treatment modality. This platform may have an especially important role in treating patients of old age and with a greater comorbid burden. We describe our institutional experience with the hybrid aortic arch approach, with midterm outcomes. ⋯ The hybrid approach to aortic arch aneurysm involving a zone 0 stent graft landing can be safely adopted with good midterm results in a cohort of old patients with significant comorbidity. This procedure can be performed with no type 1 or 3 endoleaks and may represent a technical advancement in the field of aortic arch surgery.