The Annals of thoracic surgery
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Meta Analysis Comparative Study
Comparison of graft patency between off-pump and on-pump coronary artery bypass grafting: an updated meta-analysis.
Currently, off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) are 2 well-established therapeutic strategies for patients with coronary artery disease, and debate regarding which strategy provides superior graft patency is ongoing. The current study is a meta-analysis of randomized controlled trials that compared the graft patency between OPCAB and ONCAB. ⋯ Meta-analysis of currently available randomized controlled trials on graft patency shows that ONCAB reduces the incidence of SVG graft occlusion significantly but does not affect LIMA and radial artery graft patency compared with OPCAB.
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Comparative Study
Root stabilization of the repaired bicuspid aortic valve: subcommissural annuloplasty versus root reimplantation.
At our institution, type I bicuspid aortic valve (BAV) patients with aortic insufficiency (AI) who are candidates for valve preservation are stratified into two groups by aortic root pathology: nonaneurysmal root undergoing primary cusp repair+subcommissural annuloplasty (repair group) vs aneurysmal root undergoing primary cusp repair+root reimplantation (reimplantation group). We report outcomes of this surgical reconstructive strategy for the repaired type I BAV. ⋯ Root stabilization with the reimplantation technique significantly improves the durability of the repaired type I BAV compared with subcommissural annuloplasty. It also provides improved and sustained valve mobility (transvalvular gradients).
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Valve-sparing aortic root replacement (VSARR) is an alternative to traditional composite valve graft (CVG) root replacement. We examined early and midterm outcomes after VSARR. ⋯ Valve-sparing aortic root replacement can have excellent early and respectable midterm outcomes, even when combined with arch repair. Further follow-up remains necessary to evaluate the long-term durability of VSARR.
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Reoperations on the aortic root and distal thoracic aorta late after initial root surgery in patients with Marfan syndrome might carry high periprocedural risks and be associated with adverse early and midterm clinical outcome. ⋯ Aortic reoperations in patients with Marfan syndrome can be performed with acceptable midterm outcomes. Performed as a bailout procedure, stent grafting was not associated with increased mortality. The only strong predictor of mortality after reoperations is acute dissection at the time of the initial treatment.