The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 1980
The use of "fresh" unstented homograft valves for replacement of the aortic valve. Analysis of 8 years' experience.
Between August, 1969 and May 1978, 679 patients underwent homograft replacement of the aortic valve. Isolated elective valve replacement was performed in 411 patients. Thirty-four patients had total aortic root replacement with reimplantation of the coronary arteries. ⋯ Systemic embolism was not recorded in any patient despite the fact that anticoagulants were not used. The clinical results were judged to be good or excellent in 89% of patients. It is concluded that homograft replacement of the aortic valve gives satisfactory results with a low incidence of late valve failure.
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J. Thorac. Cardiovasc. Surg. · Jun 1980
Case ReportsPost-traumatic bronchial stenosis and acute respiratory insufficiency.
A 31-year-old woman sustained multiple injuries, including severe contusion of the right lung with massive subcutaneous emphysema. Four weeks later she was transferred to our institution with post-traumatic adult respiratory distress syndrome and carbon dioxide retention, resulting from a postlaceration stenosis of the left main-stem bronchus. Bronchoplasty was contraindicated because of the serious condition of the patient. ⋯ Bronchoplasty was performed on postadmission day 50 and resulted in gradual recovery of pulmonary function. Six months following discharge, the patient continues a steady improvement. Management of the patient's injuries represented a unique challenge previously unencountered.
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J. Thorac. Cardiovasc. Surg. · Jun 1980
Training, examination, and certification of a thoracic surgeon. A position paper of the American Board of Thoracic Surgery.
The training of a thoracic surgeon is a complex process, requiring a minimum of six to seven years. Reliable examination of the trainee is similarly complex, requiring evaluation by various methods at different periods of time. Great care has been taken to keep the methods of examination free from bias and impartial by making the Residency Review Committee for Thoracic Surgery and the American Board of Thoracic Surgery completely independent organizations, unrelated to any other national professional organization. ⋯ The process of training, examination, and certification of a thoracic surgeon has evolved based on the experience obtained over the past three decades and has repeatedly proved to provide a satisfactory measure of competency in thoracic surgery. It is an achievement of which all thoracic surgeons can feel justly proud. Modifications in the structure and function of the certification process will continue to be made as changes in our medical knowledge occur.
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J. Thorac. Cardiovasc. Surg. · Mar 1980
Neurologic dysfunction following cardiac operation with low-flow, low-pressure cardiopulmonary bypass.
A prospective 6 month study of all patients undergoing cardiac operation with cardiopulmonary bypass (CPB) was undertaken to determine the incidence of neurologic and neuropsychological dysfunction following low-flow, low-pressure CPB. Among 204 patients who underwent cardiac operation with CPB, there were seven deaths (3.4%), six who developed new motor deficits (2.9%), and 35 (17.2%) who exhibited some neurologic or neuropsychological dysfunction at discharge. ⋯ The incidence of postoperative neurologic and neuropsychological complications appears comparable to that in reports from institutions employing high CPB flow and maintaining high CPB MAP. Our results suggest that CPB pressure, per se, is not the major determinant of postoperative neurologic and neuropsychological dysfunction.
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J. Thorac. Cardiovasc. Surg. · Mar 1980
Concomitant resection of ascending aortic aneurysm and replacement of the aortic valve: operative and long-term results with "conventional" techniques in ninety patients.
We reviewed a consecutive series of 90 patients undergoing concomitant resection of ascending aortic anerysm and aortic valve replacement (AVR) utilizing noncomposite "conventional" techniques in order to assess the early and late results, to define limitations of this operative approach, and thereby to clarify the indications for composite reconstruction of the aortic root. Mean age was 55 years. Twenty percent had Marfan's syndrome, and 13% had aortic dissections. ⋯ Only one late death could be attributed to complications arising in the reconstructed aortic root. These results confirm that such simple, noncomposite techniques are safe, portend minimal risk of late complications and the attendant necessity for reoperation, and provide satisfactory long-term survival. We believe that composite techniques should be primarily reserved for selected cases of advanced necrotizing prosthetic or natural endocarditis.