The Annals of thoracic surgery
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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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We report a novel monofilament slip knot technique for bronchial ligation and for visualization of the anatomic plane during lung segmentectomy. After threading the bronchus, a slip knot is made outside the thorax. ⋯ Bronchial ligation is then performed to block the outflow of segmental air while the segment remains expanded, whereas the other segments become collapsed. This technique allows identification of the anatomic intersegmental plane, facilitating thoracoscopic anatomic lung segmentectomy.
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Aortopathy associated with bicuspid aortic valve commonly involves the ascending aorta above the sinotubular ridge, but it may also affect sinus portions of the aorta. In some persons, the enlarged portion of the aortic root is limited to the noncoronary sinus. In such patients, we have spared the remaining portions of the aortic root by replacing the ascending aorta with a polyethylene terephthalate fiber (Dacron) graft and a tongue-shaped extension of the graft, thereby replacing the noncoronary sinus. In the present study, we evaluated late outcomes of this procedure, with specific attention to the fate of aortic tissue in the remaining sinuses. ⋯ In patients with bicuspid aortic valve and aortic root enlargement related mainly to enlargement of the noncoronary sinus, limited replacement of the noncoronary sinus and ascending aorta is a safe and simple procedure that is durable in midterm follow-up.
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Comparative Study
Comparison between different risk scoring algorithms on isolated conventional or transcatheter aortic valve replacement.
There are a number of scoring systems for risk evaluation in cardiac surgery, the most important of which are the European System for Cardiac Operative Risk Evaluation (EuroSCORE), The Society of Thoracic Surgeons (STS) score, the ACEF score (acronym for age, preoperative creatinine, and ejection fraction), and more recently, the new EuroSCORE-II. The aim of our study was to analyze and compare the predictive value of these scores in patients undergoing aortic valve replacement (AVR) or transcatheter aortic valve replacement (TAVR). ⋯ Overall, 30-day mortality was best predicted by the STS score. Discrimination threshold predicting mortality was equal between all other risk calculators. Surprisingly, the new EuroSCORE-II was not superior to other models in risk prediction for AVR and TAVR patients.
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Numerous gaseous microemboli (GME) are delivered into the arterial circulation during cardiopulmonary bypass (CPB). These emboli damage end organs through multiple mechanisms that are thought to contribute to neurocognitive deficits after cardiac surgery. Here, we use hypobaric oxygenation to reduce dissolved gases in blood and greatly reduce GME delivery during CPB. ⋯ Hypobaric oxygenation is an effective, low-cost, common sense approach that capitalizes on the simple physical makeup of GME to achieve their near-total elimination during CPB. This technique holds great potential for limiting end-organ damage and improving outcomes in a variety of patients undergoing extracorporeal circulation.