The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2011
Randomized Controlled Trial Multicenter StudyAcute impact of left ventricular unloading by left ventricular assist device on the right ventricle geometry and function: effect of nitric oxide inhalation.
Left ventricular assist device (LVAD) implantation is an established option for treatment of patients with end-stage heart failure, but outcome may be worsened by right ventricular failure. The aim of this study was to evaluate the acute effect of LVAD on right ventricular geometry and function and the pulmonary circulation. The effect of inhaled nitric oxide (iNO) was assessed. ⋯ LVAD implantation markedly improved right ventricular geometry and function in most of the patients, probably by resolving left ventricular congestion and thus reducing right ventricular afterload. Beneficial effects of iNO may have been masked by more pronounced consequences of left ventricular unloading on right ventricular function.
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J. Thorac. Cardiovasc. Surg. · Apr 2011
Multicenter Study Comparative StudyAortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients.
The study's objectives were to evaluate results and identify predictors of hospital and mid-term mortality after primary isolated aortic valve replacement; compare early and mid-term survival of patients aged more than 80 years or less than 80 years; and assess the effectiveness of the logistic European System for Cardiac Operative Risk Evaluation in predicting the risk for hospital mortality in octogenarians with a logistic European System for Cardiac Operative Risk Evaluation greater than 15% who are undergoing aortic valve replacement. ⋯ This study provides contemporary data on the characteristics and outcome of patients undergoing first-time isolated aortic valve replacement.
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J. Thorac. Cardiovasc. Surg. · Apr 2011
Randomized Controlled TrialOptimized temporary biventricular pacing acutely improves intraoperative cardiac output after weaning from cardiopulmonary bypass: a substudy of a randomized clinical trial.
Permanent biventricular pacing benefits patients with heart failure and interventricular conduction delay, but the importance of pacing with and without optimization in patients at risk of low cardiac output after cardiac surgery is unknown. We hypothesized that pacing parameters independently affect cardiac output. Accordingly, we analyzed aortic flow measured with an electromagnetic flowmeter in patients at risk of low cardiac output during an ongoing randomized clinical trial of biventricular pacing (n = 11) versus standard of care (n = 9). ⋯ Temporary biventricular pacing increases intraoperative cardiac output in patients with left ventricular dysfunction undergoing cardiac surgery. Atrioventricular and interventricular delay optimization maximizes this benefit.
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J. Thorac. Cardiovasc. Surg. · Apr 2011
Prediction and perinatal management of severely restrictive atrial septum in fetuses with critical left heart obstruction: clinical experience using pulmonary venous Doppler analysis.
Up to 20% of fetuses with critical left heart obstructive lesions have highly restrictive or intact atrial septae. Although this condition is generally tolerated in utero, severe hypoxemia requiring emergency atrial septostomy often develops in newborns with restrictive atrial septum. We have reported that a pulmonary venous Doppler forward/reverse time-velocity integral ratio less than 5 is highly predictive of the need for emergency atrial septostomy. We reviewed our subsequent experience using fetal pulmonary venous Doppler patterns to identify and manage fetuses with critical left heart obstruction and suspected restrictive atrial septum. ⋯ In the fetus with critical left heart obstruction, a threshold forward/reverse time-velocity integral ratio of 3 or less optimizes specificity for predicting emergency atrial septostomy. Most late second trimester values will not change over time with regard to threshold levels.
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J. Thorac. Cardiovasc. Surg. · Apr 2011
Comparative StudySelective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages.
To assess the impact of using antegrade cerebral perfusion during aortic arch surgery on postoperative survival and neurologic outcomes. ⋯ Antegrade cerebral perfusion was associated with improved survival and neurologic outcomes in patients undergoing aortic arch surgery, especially for cases requiring prolonged aortic arch repair periods.