The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Oct 2012
Open repair of chronic distal aortic dissection in the endovascular era: Implications for disease management.
Controversy surrounds the treatment of chronic aortic dissection. Open surgical and endovascular experiences include mixed populations treated with evolving strategies and limited follow-up. We establish a standard against which endovascular repair can be compared by assessing outcomes after open repair of chronic distal aortic dissections anatomically suitable to stent-grafting. ⋯ Early outcomes are good and late outcomes are less than desirable after open repair of chronic distal aortic dissection, regardless of the extent of repair. High-risk and late-stage patients with larger and more extensive aneurysmal degeneration warrant further investigation, including the use of newer, less-invasive techniques. Select patients at risk for aneurysmal degeneration should undergo a more aggressive initial approach with aortic dissection repair.
-
J. Thorac. Cardiovasc. Surg. · Oct 2012
Comparative StudyOutcomes of less invasive J-incision approach to aortic valve surgery.
Less invasive approaches to aortic valve surgery are increasingly used; however, few studies have investigated their impact on outcome. We sought to compare clinical outcomes after these approaches with full sternotomy using propensity-matching methods. ⋯ Within that portion of the spectrum of isolated aortic valve surgery where propensity matching was possible, minimally invasive aortic valve surgery had not only cosmetic advantages, but blood product use, respiratory, pain, and resource utilization advantages over full sternotomy, and no apparent detriments. Less invasive aortic valve surgery should be considered for most aortic valve operations.
-
J. Thorac. Cardiovasc. Surg. · Oct 2012
Cardiovascular magnetic resonance imaging in assessment of intracaval and intracardiac extension of renal cell carcinoma.
About 1 in 5 patients with renal cell carcinoma have intravascular tumoral extension at presentation. Level of tumoral extension within inferior vena cava determines surgical approach, with higher extension requiring cardiopulmonary bypass. Tumoral invasion of inferior vena caval wall is associated with poor prognosis. We evaluated accuracy of magnetic resonance imaging (MRI) in assessing level of intravascular extension of renal cell carcinoma and predicting vessel wall invasion. ⋯ MRI is highly accurate in staging intravascular and intracardiac extension, aiding in accurate preoperative surgical planning. MRI may help determine prognosis of renal cell carcinoma by accurately assessing tumoral adherence to the vessel wall.
-
J. Thorac. Cardiovasc. Surg. · Oct 2012
Chronic performance of a novel radiofrequency ablation device on the beating heart: Limitations of conduction delay to assess transmurality.
The creation of consistently transmural lesions with epicardial ablation on the beating heart has represented a significant challenge for current technology. This study examined the chronic performance of the AtriCure Coolrail device (AtriCure Inc, West Chester, Ohio), an internally cooled, bipolar radiofrequency ablation device designed for off-pump epicardial ablation. The study also examined the reliability of using acute intraoperative conduction delay to evaluate lesion integrity. ⋯ The AtriCure Coolrail failed to reliably create transmural lesions. Although the Coolrail was able to create acute conduction delay, its failure to transmurally ablate the atrial myocardium left gaps along the length of the lesion, which resulted in neither chronic conduction block nor delay across any line of ablation.
-
J. Thorac. Cardiovasc. Surg. · Oct 2012
Comparative StudySequential free right internal thoracic artery grafting for multivessel coronary artery bypass grafting.
This study compared early and follow-up angiographic results of individual and sequential grafting with the free right internal thoracic artery (RITA). ⋯ Multivessel coronary artery bypass grafting with the free RITA is safe and useful. Patency rates of distal anastomoses are similar between individual and sequential grafting with the free RITA at early and follow-up angiography. When the RITA cannot be used as an in situ graft for multiple anastomoses, sequential grafting with the free RITA should be considered.