European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2013
Clinical outcomes of emergency surgery for acute type B aortic dissection with rupture.
The purpose of this study was to evaluate the clinical outcomes of emergency surgery for acute type B aortic dissection with rupture and to compare results between open surgery and thoracic endovascular aortic repair (TEVAR). ⋯ TEVAR for acute type B aortic dissection with rupture could be performed with relatively low morbidity and mortality, with no significant difference when compared with open surgery. The main objective of TEVAR for acute type B aortic dissection with rupture is control of bleeding, which can be achieved by closing the primary entry site and the secondary tear site in the descending thoracic aorta. If anatomically feasible and performed immediately, TEVAR is the treatment of choice for acute type B aortic dissection with rupture because it is less invasive than open surgery.
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Eur J Cardiothorac Surg · Aug 2013
Should aortic arch replacement be performed during initial surgery for aortic root aneurysm in patients with Marfan syndrome?
The aim of this study was to investigate whether total arch replacement (TAR) during initial surgery for root aneurysm should be routinely performed in patients with Marfan syndrome (MFS). ⋯ MFS patients undergoing elective root repair have small risk of reinterventions on the aortic arch, and primary prophylactic replacement does not seem to be justified. In patients with AAD, the need for reinterventions is precipitated by the dissection itself and not by limiting the procedure to the hemi-arch replacement in the emergency setting. Limiting surgery to the aortic root, ascending aorta and proximal aortic arch is associated with low mortality in MFS patients presenting with AAD.
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Eur J Cardiothorac Surg · Aug 2013
Implantable left ventricular assist devices as initial therapy for refractory postmyocardial infarction cardiogenic shock.
Recently, the initial therapy for refractory cardiogenic shock has largely been based on use of short-term mechanical devices with later conversion to durable options. The premise is that such patients cannot tolerate cardiopulmonary bypass and the extended surgery needed for implantable left ventricular assist device (LVAD) placement. We have adopted an alternative strategy to implant long-term LVADs as the initial device therapy in such patients. ⋯ Our data challenge the notion that patients in refractory cardiogenic shock are too ill to tolerate immediate placement of implantable LVADs. Despite the surgical challenges, a one-stop implantable LVAD approach for cardiogenic shock is feasible and may offer unique advantages over the bridge-to-bridge approach because it avoids the incremental costs, hospitalization and morbidity associated with repeated interventions.
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Eur J Cardiothorac Surg · Aug 2013
Is the new EuroSCORE II a better predictor for transapical aortic valve implantation?
Conventional surgical risk scores are used to identify suitable candidates for transapical aortic valve implantation (TA-AVI) at present. However, these scores do not consider multiple high-risk conditions, including porcelain aorta, mediastinal irradiation or frailty. The aim of this study was to compare the predictive ability of the new EuroSCORE II with the surgical risk scores currently in use. ⋯ In patients undergoing TA-AVI, the new EuroSCORE II correlates strongly with the logistic EuroSCORE, but is a poorer predictor of 30-day and in-hospital mortality than the STS score. A true transcatheter aortic valve implantation risk score would be desirable beyond the established scores.
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Eur J Cardiothorac Surg · Aug 2013
Omitting chest tube drainage after thoracoscopic major lung resection.
Absorbable mesh and fibrin glue applied to prevent alveolar air leakage contribute to reducing the length of chest tube drainage, length of hospitalization and the rate of pulmonary complications. This study investigated the feasibility of omitting chest tube drainage in selected patients undergoing thoracoscopic major lung resection. ⋯ The refined strategy for pneumostasis allowed the omission of chest tube drainage in the majority of patients undergoing thoracoscopic major lung resection without increasing the risk of adverse events, which may contribute to a fast-track surgery.