Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2016
Acute aortic dissection involving the root: operative and long-term outcome after curative proximal repair.
The aim of the study was to evaluate operative and long-term results after surgery of acute aortic dissection involving the root, in which the proximal repair consisted of curative resection of all dissected aortic sinuses and was performed using either valve-sparing root repair or complete root replacement with a valve conduit. ⋯ Curative repair of the proximal aorta in acute dissection involving the root provides favourable operative and long-term outcome with very low risk of aortic complications and/or reoperations, regardless if a valve-sparing procedure or replacement with a valve conduit is used. Valve-sparing surgery is frequently suitable, providing excellent outcome and very high durability.
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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
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
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.