The Annals of thoracic surgery
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Comparative Study
Minimally invasive and conventional aortic valve replacement: a propensity score analysis.
The study aimed to compare the short-term results of aortic valve replacement through minimally invasive and sternotomy approaches. ⋯ Our experience shows that mini-access isolated aortic valve surgery is a reproducible, safe, and effective procedure and reduces assisted ventilation duration, the need for blood product transfusion, and incidence of post-surgery atrial fibrillation.
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Comparative Study
Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era.
In the era of destination continuous flow left ventricular assist devices (LVAD), the decision of whether a patient will tolerate isolated LVAD support or will need biventricular support (BIVAD) can be challenging. Incorrect decision making with delayed right ventricular (RV) assist device implantation results in increased morbidity and mortality. Continuous flow LVADs have been shown to decrease pulmonary hypertension and improve RV function. We undertook this study to determine predictors in the continuous flow LVAD era that identify patients who are candidates for isolated LVAD therapy as opposed to biventricular support. ⋯ We present a preoperative risk calculator to determine suitability of a patient for isolated LVAD support in the current continuous flow ventricular assist device era.
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Postoperative atrial fibrillation (POAF), a frequent complication after cardiac surgery, causes morbidity and prolongs hospitalization. A significant association between circulating osteoprotegerin concentration and atrial fibrillation incidence had been identified. Osteoprotegerin/receptor activator of nuclear factor-κB/receptor activator of nuclear factor-κB ligand (RANKL) axis may also contribute to the development and progression of AF. Herein we sought to determine whether preoperative serum soluble RANKL and osteoprotegerin and soluble RANKL/osteoprotegerin ratio are associated with the incidence of POAF in cardiac surgery patients. ⋯ Elevated preoperative serum soluble RANKL level and soluble RANKL/osteoprotegerin ratio are independent predictors for POAF in patients undergoing cardiac valve surgery. These findings have important implications for identifying patients at higher risk of POAF who could be considered for prophylactic therapy.
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Comparative Study
Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery.
Hemidiaphragm paralysis from phrenic nerve injury is a known complication of congenital cardiac surgery. Return of diaphragm function has been reported; however, prior studies on this subject have been limited by small numbers, static assessment methods, or observation of plicated or non-plicated patients alone. To describe return of function, we reviewed fluoroscopy and ultrasonography in all diagnosed cases of diaphragmatic paralysis. ⋯ In the current era, return of diaphragm function after phrenic nerve injury sustained during congenital cardiac surgery is a known occurrence; however, predicting recovery continues to be difficult.
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Comparative Study
A protocol-driven approach to cardiac reoperation reduces mortality and cardiac injury at the time of resternotomy.
The purpose of this study was to determine whether an established protocol-driven approach to cardiac reoperations would improve patient outcomes and reduce resternotomy injuries. ⋯ A protocol-driven approach to cardiac reoperations is associated with reduced cardiac injury upon resternotomy and decreased mortality. The protocol-driven use of routine preoperative computed tomography angiography, alternative cannulation planning, avoidance of prior internal mammary artery grafts, and the early initiation of cardiopulmonary bypass before sternotomy for selected cases should be considered to improve operative results and efficiency.