The heart surgery forum
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The heart surgery forum · Aug 2011
Comparative StudyImpact of race on mitral procedure selection and short-term outcomes of patients undergoing mitral valve surgery.
Racial disparity with respect to mitral valve (MV) surgery has been documented; however, previous reports have been limited by small numbers, focus on patients undergoing MV replacement only, or comparison of African-American patients to white patients. Using more recent data from the largest all-payer database in the United States, we examined whether type of mitral procedure performed was influenced by race and whether racial differences exist in baseline characteristics and short-term outcomes of patients undergoing mitral repair or replacement for MV disease. ⋯ African-Americans and Hispanics present for MV surgery with worse preoperative profiles and undergo mitral repair less often compared to whites. Although in-hospital mortality was not influenced by race, African-Americans and Hispanics had a more protracted hospital course even following adjustment. The disparity in mitral procedure selection among racial groups was present only prior to adjustment for important baseline characteristics. Nevertheless, this racial difference reflects current reality in surgical practice and identifies an important area for future improvement in the care of patients with valvular heart disease.
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The heart surgery forum · Aug 2011
Case ReportsRadical and harmless shave resection of atypical papillary fibroelastomas of the cardiac valves.
Papillary fibroelastomas (PFEs) are rare cardiac tumors usually treated by shave resection. Up to 20% of the patients are actually denied such a conservative surgical approach because atypical morphology is thought to preclude radical and effective outcomes. ⋯ In experienced hands surgical shave resection is the gold standard for the treatment of PFE even in atypical presentations.
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The heart surgery forum · Aug 2011
Case ReportsSurgical repair of a giant atrial septal aneurysm with patent foramen ovale.
Atrial septal aneurysm (ASA) is a rare occurrence. Many studies have established a correlation between ASA and both ischemic stroke of unidentified cause and cardiac embolism. ⋯ Although the detailed mechanism involved in the degeneration of the atrial septum is unclear, we recommend that such damage be surgically repaired to reduce the risk of cerebral embolism or heart failure in symptomatic patients. Surgery is recommended for larger ASA.
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The heart surgery forum · Aug 2011
Case ReportsAortoesophageal fistula secondary to thoracic endovascular aortic repair of a descending aortic aneurysm rupture.
We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture. ⋯ AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.