Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2013
Multicenter StudyEarly and late outcomes of total repair of tetralogy of Fallot: risk factors for late right ventricular dilatation.
This study was undertaken to assess the early and long-term results of total repair of tetralogy of Fallot (TOF) and to identify the risk factors associated with late right ventricular (RV) dilatation. ⋯ Total correction of TOF can be performed with a very low mortality rate. However, the postoperative re-operation or re-intervention rates remain relatively high. Late RV dilatation after total repair of TOF was found to be associated with transannular patch enlargement and a longer postoperative ventilator support period.
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Interact Cardiovasc Thorac Surg · Nov 2013
Multicenter Study Clinical TrialAortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future?
Aortic valve replacement (AVR) in geriatric patients (>75 years) with small aortic roots is a challenge. Patient-prosthesis mismatch and the long cross-clamp time necessary for stentless valves or root enlargement are matters of concern. We compared the results of AVR with sutureless valves (Sorin Perceval), against those with conventional biological valves. ⋯ This study highlights the advantages of sutureless valves for geriatric patients with small aortic roots reflected by shorter cross-clamp and CPB times, even though most of these patients were operated on via a minimally invasive access. Moreover, due to the absence of a sewing ring, these valves are also almost stentless, with greater effective orifice area (EOA) for any given size. This may potentially result in better haemodynamics even without the root enlargement. This is of advantage, as several studies have shown that aortic root enlargement can significantly increase the risks of AVR. Moreover, as seen in this series, these valves may also enable a broader application of minimally invasive AVR.
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Interact Cardiovasc Thorac Surg · Nov 2013
Multicenter StudyThe influence of seasons and lunar cycle on hospital outcomes following ascending aortic dissection repair.
The effect of the lunar cycle and seasonal variation on ascending aortic dissection surgery outcomes is unknown. We investigated these temporal effects on risk-adjusted hospital mortality and then on the length of stay (LOS) following surgery for survivors. ⋯ Season had no effect on mortality or LOS following aortic dissection repair, while patient age significantly increased the odds of death. The full-moon cycle appeared to reduce the odds of death, and the full-moon cycle, along with being male and requiring a concomitant cardiac procedure, was associated with shorter LOS.
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Interact Cardiovasc Thorac Surg · Oct 2013
Multicenter Study Observational StudyImpact of occult renal impairment on early and late outcomes following coronary artery bypass grafting.
High serum creatinine is considered an independent risk factor for poor outcomes following coronary artery bypass grafting (CABG). However, the impact of occult renal impairment (ORI), defined as an impaired glomerular filtration rate (GFR) with a normal serum creatinine (SCr) level, remains unclear. Thus, we sought to investigate the impact of ORI on outcomes after CABG. ⋯ ORI was an independent risk factor for early and late death as well as cardiovascular events in patients undergoing CABG with normal SCr levels. A more accurate evaluation of renal function through a combination of SCr and estimated GFR is needed in patients with normal SCr levels.
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Interact Cardiovasc Thorac Surg · Oct 2013
Multicenter StudyFeasibility and safety of minimized cardiopulmonary bypass in major aortic surgery.
Conventional cardiopulmonary bypass causes haemodilution and is a trigger of systemic inflammatory reactions, coagulopathy and organ failure. Miniaturized cardiopulmonary bypass has been proposed as a way to reduce these deleterious effects of conventional cardiopulmonary bypass and to promote a more physiological state. The use of miniaturized cardiopulmonary bypass has been reported in low-risk patients undergoing valve and coronary artery bypass graft (CABG) surgery. However, little is known about its application in major aortic surgery. ⋯ Our experience suggests that miniaturized cardiopulmonary bypass is safe and feasible for use in major aortic cardiac surgery. A randomized trial is needed to evaluate miniaturized cardiopulmonary bypass formally.