European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · May 2003
Review Meta AnalysisChoice of a mechanical valve or a bioprosthesis for AVR: does CABG matter?
Mechanical valves and bioprostheses are the commonly used devices in aortic valve replacement (AVR). Many patients with valvular disease also require concomitant coronary artery bypass grafting (CABG). We used a microsimulation model to provide insight into the outcomes of patients after AVR with mechanical valves and stented bioprostheses, with and without CABG, and to determine the age-thresholds or age crossover points in outcomes between the two valve types. ⋯ The currently recommended patient age for using a bioprosthesis (65 years) could be lowered further, irrespective of concomitant CABG. The trade-off between the reduced risks of bioprosthetic failure and of hemorrhage in mechanical valves, resulting from a lower LE, minimized the effect of CABG on the age crossover points between the two valve types.
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Eur J Cardiothorac Surg · May 2003
Increasing experience with integrated approach to pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.
To validate the preliminary surgical results of 'integrated approach' to pulmonary atresia, ventricular septal defect (VSD), and multiple aortopulmonary collateral arteries by retrospective analysis of our center experience. ⋯ Increasing experience with 'integrated approach' to pulmonary atresia, VSD, and multiple aortopulmonaty collaterals has confirmed the preliminary results of our surgical series. The pulmonary flow study remains the most accurate intraoperative test for successful management of VSD during unifocalization procedures
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Blunt traumatic rupture of the innominate artery is uncommon. We reviewed our experience to correlate the impact of patient stability, presence of associated injuries and location of the injury within the artery with outcome. ⋯ Patients with blunt innominate artery rupture who survive to admission are usually stable and the diagnosis is suggested by initial chest radiograph. The injuries are usually proximal, requiring aortic-distal innominate bypass. Cardiopulmonary bypass is required only if there is evidence of heart failure (either before or after partial occlusion of the aorta) or to manage specific associated injuries.
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Eur J Cardiothorac Surg · May 2003
Technical advances of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension.
To minimize the side-effects of circulatory arrest times and profound hypothermia in patients undergoing pulmonary thromboendarterectomy (PTE) for chronic thromboembolic pulmonary hypertension (CTEPH). ⋯ These technical advances improve neurological outcome, control back-bleeding from bronchial arteries and avoid prolonged rewarming phases in patients undergoing PTE.