The Annals of thoracic surgery
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Comparative Study
Operative strategy for acute type a aortic dissection: ascending aortic or hemiarch versus total arch replacement with frozen elephant trunk.
This report compares long-term results with total arch replacement with frozen elephant trunk (FET) to ascending aortic or hemiarch replacement (AHR) for acute type A aortic dissection. ⋯ In patients with acute type A aortic dissection, it is possible to perform extensive primary repair using the FET technique with relative safety. FET may reduce the necessity for further operations to manage a residual false lumen.
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We reviewed our experience at the Montreal Heart Institute with early surgical and percutaneous closure of postinfarction ventricular septal defects (VSD). ⋯ Small or medium VSDs can be treated definitively with a ventricular septal occluder or initially to stabilize patients and allow myocardial fibrosis, thus facilitating delayed subsequent surgical correction.
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There is no agreement whether off-pump coronary artery bypass (OPCAB) can reduce mortality, rates of stroke, myocardial infarction, or revascularization when compared with conventional coronary artery bypass (CCAB). We performed a meta-analysis comparing off-pump coronary artery bypass with conventional coronary artery bypass in randomized controlled trials. ⋯ In conclusion, OPCAB did not significantly reduce 1-year mortality, stroke, myocardial infarction, and revascularization compared with CCAB.
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Comparative Study
Adult congenital heart surgery: adult or pediatric facility? Adult or pediatric surgeon?
One of the current controversies in the field of adult congenital heart disease is whether patients should be cared for at an adult or pediatric facility and by an adult or pediatric heart surgeon. After transitioning our program from the children's hospital to the adult hospital, we analyzed our experience with each system. ⋯ Congenital heart surgery can be performed in adults with reasonable morbidity and mortality. Caring for an anticipated aging adult congenital population with increasingly numerous coexisting medical problems and risk factors is best facilitated in an adult hospital setting. Also, when surgery becomes necessary, these adult patients are best served by a congenital heart surgeon.
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Case Reports
Nonmycotic false aneurysm of aortic cannulation site presenting 26 years postoperatively.
We report the case of a 64-year-old woman who presented with a false aneurysm in the ascending aorta where arterial cannulation was done in an operation 26 years earlier. The aneurysm was excised with the ascending aorta and successfully replaced with a prosthetic graft during deep hypothermic circulatory arrest and retrograde cerebral perfusion, accompanied with concomitant procedures of mitral valve replacement and maze procedure. When the aneurysm, 3.5 x 3.0 x 4.5 cm, was removed, it showed a remarkable sharp line of demarcation between the normal aorta. Microscopic examination of the specimen was consistent with the features of a pseudoaneurysm.