European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Feb 2014
The efficacy and short-term results of hybrid thoracic endovascular repair into the ascending aorta for aortic arch pathologies.
Conventional total aortic arch repair is a high-risk procedure, particularly for high-risk patients. Although endovascular treatment of aortic arch aneurysm is a recently induced procedure, only a few cases are indicated and outcomes are questionable. Here, we report on the early and short-term results of our surgical procedure, i.e. hybrid arch repair with supra-aortic debranching and endografting into the ascending aorta. ⋯ We achieved satisfactory early and short-term results with hybrid arch repair into the ascending aorta. Our findings suggest that hybrid repair into the ascending aorta may be a viable option for high-risk patients with aortic arch pathologies.
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Eur J Cardiothorac Surg · Feb 2014
Review Meta AnalysisIndexed effective orifice area is a significant predictor of higher mid- and long-term mortality rates following aortic valve replacement in patients with prosthesis-patient mismatch.
Prosthesis-patient mismatch (PPM) is defined as a too-small effective orifice area (EOA) of an inserted prosthetic relative to body size, resulting in an abnormally high postoperative gradient. It is unclear, however, whether residual stenosis after aortic valve replacement (AVR) has a negative impact on mid- and long-term survivals. We searched electronic databases, including PubMed, Embase, Medline and the Cochrane controlled trials register, through October 2012, to identify published full-text English studies on the association between PPM and mortality rates. ⋯ Regardless of severity, however, PPM had a negative effect on survival in patients with impaired ejection fraction (adjusted HR 1.26, 95% CI 1.09-1.47). PPM (iEOA<0.85 cm2/m2) after AVR tended to be associated with increased long-term all-cause mortality in younger patients, females and patients with preoperative left ventricular dysfunction. Severe PPM (iEOA<0.65 cm2/m2) was a significant predictor of reduced long-term survival in all populations undergoing AVR.
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Eur J Cardiothorac Surg · Feb 2014
Decreased von Willebrand factor ristocetin cofactor activity and increased ADAMTS13 antigen increase postoperative drainage after coronary artery bypass grafting.
Routine coagulation tests and bleed-scores fail to identify patients at risk of excessive postoperative drainage following coronary artery bypass grafting (CABG). We sought to investigate whether lower von Willebrand factor (VWF) and higher ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) are associated with a high postoperative drainage after CABG. ⋯ Patients undergoing elective CABG with lower preoperative VWF:RCO are at risk of having larger postoperative drainage, which suggests a novel contributor to increased perioperative bleeding in cardiac surgery.
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Eur J Cardiothorac Surg · Feb 2014
Observational StudyResults of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery.
Survival of children having cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest following surgical correction of congenital heart disease. ⋯ ECPR plays a valuable role in children having refractory postoperative cardiac arrest. Survival is unrelated to cardiac physiology or surgical complexity. Timely support prior to the emergence of end-organ injury and surgical correction of residual cardiac lesions might enhance survival.
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Eur J Cardiothorac Surg · Feb 2014
Impact of afterload reduction strategies on regional tissue oxygenation after the Norwood procedure for hypoplastic left heart syndrome.
Low cerebral tissue oxygenation saturations have been observed by near-infrared spectroscopy (NIRS) after the Norwood procedure. Altered cerebral vascular resistance and pharmacological afterload reduction redirecting blood flow away from the cerebral circulation are possible mechanisms. ⋯ The postoperative decline of cerebral tissue oxygen saturation was observed with both afterload reduction strategies. The difference between cerebral and somatic NIRS values may indicate a mismatch between cerebral and splanchnic oxygenation. Other strategies to improve cerebral tissue oxygenation are warranted.