The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: a prospective study.
Our objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs. ⋯ In neonatal and infant open heart repairs, technical performance score is one of the main predictors of postoperative morbidity. Outcomes are not affected by intraoperative adverse events, including surgical revisions, provided technical performance score is at least adequate.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Comparative StudyReversible pulmonary trunk banding. VI: Glucose-6-phosphate dehydrogenase activity in rapid ventricular hypertrophy in young goats.
Increased myocardial glucose-6-phosphate dehydrogenase (G6PD) activity occurs in heart failure. This study compared G6PD activity in 2 protocols of right ventricle (RV) systolic overload in young goats. ⋯ Continuous systolic overload for ventricle retraining causes RV dysfunction and upregulation of myocardial G6PD activity, which can elevate levels of free radicals by NADPH oxidase, an important mechanism in the pathophysiology of heart failure. Intermittent systolic overload promotes a more efficient RV hypertrophy, with better preservation of myocardial performance and and less exposure to hypertrophic triggers.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Hemodynamics and myocardial blood flow patterns after placement of a cardiac passive restraint device in a model of dilated cardiomyopathy.
The present study examined a cardiac passive restraint device which applies epicardial pressure (HeartNet Implant; Paracor Medical, Inc, Sunnyvale, Calif) in a clinically relevant model of dilated cardiomyopathy to determine effects on hemodynamic and myocardial blood flow patterns. ⋯ In a large animal model of dilated cardiomyopathy, the cardiac passive restraint device did not appear to adversely affect basal resting myocardial blood flow. However, after acute HeartNet Implant placement, left ventricular maximal coronary reserve was blunted. These unique results suggest that cardiac passive restraint devices that apply epicardial transmural pressure can alter myocardial blood flow patterns in a model of dilated cardiomyopathy. Whether this blunting of coronary reserve holds clinical relevance with chronic passive restraint device placement remains unestablished.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Wave energy patterns of counterpulsation: a novel approach with wave intensity analysis.
In counterpulsation, diastolic augmentation increases coronary blood flow and systolic unloading reduces left ventricular afterload. We present a new approach with wave intensity analysis to revisit and explain counterpulsation principles. ⋯ Intra-aortic balloon pumps generate backward-traveling waves that predominantly drive aortic and coronary blood flow during counterpulsation. Wave intensity analysis of arterial circulations may provide a mechanism to explain diastolic augmentation and systolic unloading of intra-aortic balloon pump counterpulsation.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
The impact of body mass index on morbidity and short- and long-term mortality in cardiac valvular surgery.
Limited data exist on patients with cardiac cachexia or morbid obesity presenting for valvular heart surgery. The objective of this study was to investigate the relationship between body mass index and morbidity and mortality after valvular surgery. ⋯ Patients with body mass index 24 or less are at significantly increased risk of in-hospital and long-term mortality after cardiac valvular surgery. This high-risk patient population warrants careful risk stratification and options for less-invasive valve therapies.