The Annals of thoracic surgery
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Surgical techniques for aortic valve (AV) repair are directed toward restoring normal structural relationships in the aortic root and rely on detailed assessment of root and valve anatomy. Noninvasive three-dimensional (3D) imaging and modeling may assist in patient selection and operative planning. ⋯ High-resolution 3D models of the in vivo normal human aortic root and valve were generated using 3D echocardiography. Quantitative 3D models and analysis may assist in characterization of pathology and decision making for AV repair.
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Observational Study
Low preoperative fibrinogen plasma concentration is associated with excessive bleeding after cardiac operations.
Data from small selected patient populations suggest that the preoperative plasma concentration of fibrinogen influences postoperative blood loss and red blood cell transfusion after cardiac operations, but there are also conflicting reports. We assessed the importance of preoperative fibrinogen concentration for excessive bleeding and red cell blood transfusion in a large cohort of mixed cardiac surgical patients. ⋯ Preoperative plasma concentration of fibrinogen is independently associated with excessive bleeding after cardiac operations but not with red blood cell transfusion.
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Improved outcomes as well as lack of donor hearts have increased the use of ventricular assist devices (VADs), rather than inotropic support, for bridging to transplantation. Recognizing that organ allocation in the highest status patients remains controversial, we sought to compare outcomes of patients with VADs and those receiving advanced medical therapy. ⋯ Although posttransplantation survival is better for patients who are bridged to transplantation with inotropic treatment only, the cost of failure of inotropic agents is significant, with a nearly doubled mortality for those who later require VAD support. Survival on the waiting list appears to be improved among patients receiving VAD support. Careful selection of the appropriate bridging strategy continues to be a significant clinical challenge.
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Thoracic radiation leads to radiation-associated cardiac disease (RACD), associated with substantial cardiac morbidity and mortality, often requiring complex cardiothoracic surgery. In patients with RACD, along with valvular lesions, the aorto-mitral curtain (AMC, junction between base of anterior mitral leaflet and aortic root) thickness is increased on transthoracic echocardiography. We sought to identify clinical and transthoracic echocardiography predictors of long-term mortality in patients with RACD. ⋯ Patients with RACD undergoing cardiothoracic surgery have high long-term mortality, which is independently predicted by AMC thickness, a higher preoperative risk score, and lack of cardioprotective medications.
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Right heart failure is poorly understood and treated. In left heart failure, ventricular restraint can reverse pathologic left ventricular remodeling. The effect of restraint in right heart failure, however, is not known. We hypothesize that ventricular restraint can be applied selectively to the right ventricle (RV) to promote RV reverse remodeling. ⋯ A model of ischemic right heart failure was successfully created. Selective RV restraint results in improved mechanical efficiency, decreased wall stress, and improved EF. The benefits of restraint in right heart failure warrant further investigation.