The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2012
Prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery.
We sought to determine the value of preoperative left ventricular function and cardiopulmonary bypass parameters in the prediction of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. ⋯ The fractional shortening and aortic crossclamp time together predict 80.9% of the variability in postrepair left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery. When preoperative left ventricular dysfunction is severe (fractional shortening < 20%), an aortic crossclamp time greater than 56 minutes is associated with a substantial risk of left ventricular assist device implantation after repair of anomalous left coronary artery from the pulmonary artery.
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J. Thorac. Cardiovasc. Surg. · Jul 2012
Fifteen-year single-center experience with the Norwood operation for complex lesions with single-ventricle physiology compared with hypoplastic left heart syndrome.
The Norwood procedure, the first surgical step of staged palliation for hypoplastic left heart syndrome, is also applied for other complex single-ventricle lesions with systemic outflow tract obstruction or aortic arch hypoplasia. We reviewed our 15-year institutional experience with the Norwood procedure for patients with and without hypoplastic left heart syndrome. ⋯ Early and long-term survivals and postoperative complications were similar between patients with and without hypoplastic left heart syndrome undergoing a Norwood operation. Recurrent aortic arch obstruction was common in both groups but more prevalent in patients without hypoplastic left heart syndrome.
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J. Thorac. Cardiovasc. Surg. · Jul 2012
miRNA-141 is a novel regulator of BMP-2-mediated calcification in aortic stenosis.
Bone morphogenetic protein-2 (BMP-2) is a major regulator of aortic valve calcification. MicroRNAs (miRNAs) are essential post-transcriptional modulators of gene expression and miRNA-141 is a known repressor of BMP-2-mediated osteogenesis. We hypothesized that miRNA-141 is a key regulator of aortic valve calcification. ⋯ We report a completely novel role of miRNA-141 as a regulator of BMP-2-dependent aortic valvular calcification and demonstrate marked attenuation of miRNA-141 expression in patients with bicuspid aortic valve-associated aortic stenosis. Therapeutic targeting of miRNA-141 could serve as a novel strategy to limit progressive calcification in aortic stenosis.
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J. Thorac. Cardiovasc. Surg. · Jul 2012
Early thrombosis risk in patients with biologic valves in the aortic position.
Patients who require aortic valve replacement are increasingly receiving biologic valves to avoid long-term anticoagulation. The thromboembolic risk of bioprosthetic valves is reportedly low. The study objective was to review the incidence of early valve thrombosis requiring reoperation in patients who received a bioprosthetic valve in the aortic position. ⋯ The incidence of early thrombosis of porcine aortic bioprostheses requiring reoperation was not insignificant. Potential causes and mechanisms for such thrombosis are unknown. Recognition of this unanticipated problem and reoperation resulted in a satisfactory outcome for patients.