The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2022
Artificial papillary muscle device for off-pump transapical mitral valve repair.
New transapical minimally invasive artificial chordae implantation devices are a promising alternative to traditional open-heart repair, with the potential for decreased postoperative morbidity and reduced recovery time. However, these devices can place increased stress on the artificial chordae. We designed an artificial papillary muscle to alleviate artificial chordae stresses and thus increase repair durability. ⋯ Our novel artificial papillary muscle could integrate with minimally invasive repairs to shorten the artificial chordae and behave as an elastic damper, thus reducing sharp increases in force. With our device, we have the potential to improve the durability of off-pump transapical mitral valve repair procedures.
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J. Thorac. Cardiovasc. Surg. · Oct 2022
Noninvasive surrogates are poor predictors of liver fibrosis in patients with Fontan circulation.
Patients with Fontan circulation exhibit a high incidence of liver fibrosis and cirrhosis. Transient elastography (TE) and the enhanced liver fibrosis (ELF) test have proven useful as noninvasive surrogate markers of liver fibrosis for other chronic liver diseases. We evaluated whether TE and the ELF score can predict the degree of liver fibrosis in patients with Fontan circulation. ⋯ TE and the ELF score were unable to predict the degree of liver fibrosis in Fontan patients. Liver biopsy remains as the only valid method to assess fibrotic burden in this population.
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J. Thorac. Cardiovasc. Surg. · Oct 2022
Repair of complete atrioventricular septal defect between 2 and 3.5 kilograms: Defining the limits of safe repair.
Repair of complete atrioventricular septal defect (cAVSD) is routinely performed at around 3 months of age with good results. However, some patients require earlier surgery due to heart failure or failure to thrive. It is uncertain whether cAVSD repair performed on patients ≤3.5 kg leads to increased mortality and reoperation on the left atrioventricular valve. ⋯ Repair of cAVSD in children ≤3.5 kg appears to be safe, with similar overall survival and freedom from reoperation compared with those >3.5 kg. These findings add further support to an approach of early complete repair in children with severe heart failure or failure to thrive.
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J. Thorac. Cardiovasc. Surg. · Oct 2022
Global best practices consensus: Long-term management of patients with hybrid centrifugal flow left ventricular assist device support.
Six months after withdrawal of the HeartWare HVAD System (HVAD; Medtronic) from sale, approximately 4000 patients continue ongoing support with this device. In light of the diminishing experience, this global consensus document summarizes key management recommendations. ⋯ With decreasing worldwide experience in the ongoing management of HVAD-supported patients, this consensus guideline provides a summary of best practice techniques from international centers. Differences in HeartMate 3 management are highlighted.
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J. Thorac. Cardiovasc. Surg. · Oct 2022
Preoperative left ventricular end-systolic dimension predicts occurrence of aortic insufficiency following aortic valve preservation and repair surgery.
Preoperative left ventricular (LV) end-systolic dimension (LVESD) ≥5.0 cm is a class IIa indication for surgical intervention for aortic insufficiency (AI); however, the effect of LV dilatation on the longevity of the aortic valve (AV) has not yet been investigated. This study aimed to assess the impact of preoperative LV dimension on the long-term outcome of AV preservation surgery. ⋯ Preoperative LVESDi ≥2 cm/m2 is associated with increased risk of recurrent >1+ AI following AV preservation surgery. Further investigation of the appropriate operative threshold for AI may be warranted.