The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Aortic root aneurysm: principles of repair and long-term follow-up.
This study was undertaken to examine clinical and echocardiographic outcomes of aortic valve-sparing operations to treat aortic root aneurysms. ⋯ Aortic valve-sparing operations provide excellent patient survival and stable aortic valve function, particularly after reimplantation of the aortic valve.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Veno-arterial extracorporeal membrane oxygenation using Levitronix centrifugal pump as bridge to decision for refractory cardiogenic shock.
Cardiogenic shock still carries a very high mortality. We adopted veno-arterial extracorporeal membrane oxygenation using the Levitronix centrifugal pump (Levitronix LLC, Waltham, Massachusetts) as a first-line treatment of cardiogenic shock in a "bridge to decision" strategy. This article provides our experience of this clinical approach. ⋯ In our experience, the use of veno-arterial extracorporeal membrane oxygenation as bridge to decision has been effective to promptly restore adequate systemic perfusion, allowing further time to evaluate myocardial recovery or candidacy for ventricular assist device or heart transplantation. Younger patients, with no or mild end-organ injury, had the best outcomes. Peripheral cannulation decreases the surgical trauma and makes emergency implantation possible, even in the intensive care unit.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Neuromonitor-guided repair of thoracoabdominal aortic aneurysms.
Monitoring during thoracoabdominal aortic aneurysm repair has included the use of cerebrospinal fluid drainage and motor and somatosensory evoked potentials. We report our experience with neuromonitoring-guided thoracoabdominal aortic aneurysm repair. ⋯ Neuromonitoring using somatosensory evoked potentials and motor evoked potentials seems useful during thoracoabdominal aortic aneurysm repair. Alterations in intraoperative conduct resulted in return of neuromonitoring signals. This suggests a benefit in intercostal artery reimplantation via increasing perfusion to the collateral network of the spinal cord. Further studies using neuromonitoring-guided repair of thoracoabdominal aortic aneurysms are warranted.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Valve-preserving root replacement in bicuspid aortic valves.
Bicuspid aortic valve anatomy is associated with aortic root aneurysm in a relevant proportion of patients. These patients require root replacement for prognostic reasons, and the valve may be preserved. The objective of this analysis is to analyze the early and late outcomes of root remodeling for bicuspid aortic valve. ⋯ Root remodeling for aortic root aneurysm in the presence of a bicuspid aortic valve can be performed with a low morbidity and mortality. The long-term stability of the reconstructed aortic valve is excellent if normal valve configuration is achieved. The occurrence of late stenosis seems to be rare, and freedom from valve-related complications is high.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Renal injury is associated with operative mortality after cardiac surgery for women and men.
The purpose of this study was to determine whether acute renal injury develops more frequently in women than in men after cardiac surgery and whether this complication is associated with operative mortality in women. ⋯ Postoperative renal injury is independently associated with 30-day mortality regardless of patient sex. Higher rates of renal injury in women compared with men might be explained in part by a higher prevalence of low estimated glomerular filtration rate before surgical intervention.