Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2016
Comparative StudyMedtronic Freestyle aortic bioprosthesis: a potential option for haemodialysis patients†.
End-stage renal disease patients on regular haemodialysis are at higher risk of calcification. Therefore, many surgeons have concerns regarding the implantation of bioprostheses in such patients. The haemodynamic advantages of stentless aortic bioprostheses support their use; however, these have not been studied yet in end-stage renal disease patients. We studied accordingly the early and mid-term outcomes of aortic valve replacement (AVR) using Medtronic Freestyle stentless aortic bioprostheses in this subset of patients in comparison with stented aortic bioprostheses. ⋯ Aortic bioprostheses are a good option for haemodialysis patients requiring AVR, offering acceptable mid-term survival. The Medtronic Freestyle aortic bioprostheses could allow the implantation of larger bioprostheses inferring consequently lower mean gradients, with a potentially higher resistance to calcification and sclerosis in haemodialysis patients.
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Interact Cardiovasc Thorac Surg · Apr 2016
Observational StudyAortic valve replacement for severe aortic regurgitation in asymptomatic patients with normal ejection fraction and severe left ventricular dilatation.
According to current guidelines, aortic valve surgery is a Class II indication for asymptomatic patients with severe aortic regurgitation (AR) accompanied by left ventricular (LV) ejection fraction (LVEF) ≥ 50% and left ventricular end-diastolic dimension (LVEDD) >70 mm. This study aims to assess the postoperative outcomes of asymptomatic patients with severe AR accompanied by LVEF ≥ 50% and LVEDD >70 mm after aortic valve replacement (AVR) and to identify prognostic indicators of the surgery, especially in terms of LV ejection fraction and degree of LV dilatation. ⋯ AVR can be performed with satisfactory outcomes for severe aortic regurgitation in asymptomatic patients with severe AR accompanied by LVEF ≥ 50% and LVEDD > 70 mm. It is observed that 50% ≤ LVEF < 55% or LVEDD ≥ 81 mm are associated with poorer prognosis in patients undergoing AVR.
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Interact Cardiovasc Thorac Surg · Apr 2016
Comparative StudyExtracorporeal membrane oxygenation as a bridge to lung transplantation: what lessons might we learn from volume and expertise?
We sought to evaluate the effect of centre volume on survival when extracorporeal membrane oxygenation (ECMO) is used as a bridge to lung transplantation (LTx). ⋯ Lowest volume centres have lowest survival and there exists a volume threshold at which better outcomes are achieved.
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Interact Cardiovasc Thorac Surg · Apr 2016
Observational StudyPerioperative optimal blood pressure as determined by ultrasound tagged near infrared spectroscopy and its association with postoperative acute kidney injury in cardiac surgery patients.
Perioperative blood pressure management by targeting individualized optimal blood pressure, determined by cerebral blood flow autoregulation monitoring, may ensure sufficient renal perfusion. The purpose of this study was to evaluate changes in the optimal blood pressure for individual patients, determined during cardiopulmonary bypass (CPB) and during early postoperative period in intensive care unit (ICU). A secondary aim was to examine if excursions below optimal blood pressure in the ICU are associated with risk of cardiac surgery-associated acute kidney injury (CSA-AKI). ⋯ Optimal blood pressure during CPB and in the ICU was correlated. Excursions below optimal blood pressure (AUC < OptMAP mmHgXh) during perioperative period are associated with CSA-AKI. Individualized blood pressure management based on cerebral autoregulation monitoring during the perioperative period may help improve CSA-AKI-related outcomes.
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Interact Cardiovasc Thorac Surg · Apr 2016
Multicenter StudySurvival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients.
The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort. ⋯ Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.