The Annals of thoracic surgery
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Comparative Study
Isolated reoperative minimally invasive tricuspid valve operations.
Tricuspid valve (TV) regurgitation has recently been identified as a major risk factor for long-term mortality. Isolated reoperative tricuspid valve repair/replacement (TVR/r) carries an excessively high operative risk. Currently, isolated TVR/r with minimally invasive access through a right lateral thoracotomy is being used increasingly in our institution to treat progressive TV pathologic processes after previous cardiac operations. We analyzed our early and midterm results with reoperative TVR/r in this unique patient cohort. ⋯ Minimally invasive access through a right thoracotomy provides a safe option for reoperative TVR and offers excellent early outcome, particularly in elective cases. Surgical intervention should be performed earlier rather than later.
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Empiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome. ⋯ Patients with cirrhosis undergoing heart surgery with extracorporeal circulation have a poor prognosis. Several preoperative factors are related to outcome. EuroSCORE and MELD score may help to evaluate operation risk and indication.
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Comparative Study
Red blood cell transfusion is associated with troponin release after elective off-pump coronary artery bypass surgery.
Increased troponin levels after coronary artery bypass surgery are associated with increased risk of early and late mortality. We hypothesized that perioperative blood transfusion is associated with increased postoperative troponin release. ⋯ Red blood cell transfusion is associated with increased troponin I release after elective off-pump coronary artery bypass graft surgery independently of hemoglobin and hematocrit nadirs. These findings suggest that prevention of major bleeding requiring blood transfusion may be cardioprotective during coronary surgery. Further studies are needed to verify whether troponin release is affected simply by RBC transfusion or by unstable hemodynamic conditions in presence of mild and severe anemia.
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Comparative Study
Salvage esophagectomy for locoregional failure after chemoradiotherapy in patients with advanced esophageal cancer.
Definitive chemoradiotherapy is associated with high local treatment failure rates, and surgical resection may be an appropriate salvage therapy. However, the efficacy and safety of salvage esophagectomy have not been elucidated fully. The clinical outcomes of salvage esophagectomy for locoregional failure after chemoradiotherapy were assessed. ⋯ While salvage esophagectomy for locoregional failure after chemoradiotherapy should be employed with great caution, it appears to be a feasible and effective therapeutic option for highly selected patients, especially with early pathologic stage disease. Salvage esophagectomy can be recommended as the only current curative treatment option for patients with locoregional failure after chemoradiotherapy.
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Valve-in-valve implantation for degenerated surgical bioprosthetic valves is becoming an increasingly accepted approach in selected high-risk patients. In the past, valve-in-valve implantations have been mainly performed in aortic position and only rarely in mitral position. We describe the case of an 81-year-old female patient with severe mitral regurgitation of a degenerated Carpentier-Edwards biological prosthesis treated by transfemoral and transseptal implantation of a SAPIEN-XT valve.