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 2016
Reoperation for right ventricular outflow tract obstruction after arterial switch operation for transposition of the great arteries and aortic arch obstruction.
Right ventricular outflow tract obstruction (RVOTO) is one of the reasons for late reinterventions after repair of transposition of the great arteries (TGA) with aortic arch obstruction (AAO). The aim of the present study was to identify predictors of reoperation for RVOTO in patients who underwent arterial switch operation (ASO) and arch repair for TGA or Taussig-Bing anomaly with AAO. ⋯ Taussig-Bing anomaly and smaller preoperative aortic annulus diameter (Z-score) were significant predictors of reoperation for RVOTO in patients after ASO for TGA or Taussig-Bing anomaly with AAO. In Taussig-Bing hearts, the more complex anatomy often necessitates modifications of the operation technique, sometimes precluding RVOT relief at primary ASO. During follow-up, the possibility of recurrent RVOTO should always be considered in this specific patient population. Yet, in case of a reoperation for RVOTO, the surgical relief is in general effective.
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Eur J Cardiothorac Surg · May 2016
Can radiological characteristics of preoperative cerebral lesions predict postoperative intracranial haemorrhage in endocarditis patients?
Infective endocarditis (IE) is associated with high mortality (20-40%) and neurological complications (20-50%). Postoperative intracranial haemorrhage (ICH) is a feared complication especially in patients with preoperative cerebral infarcts. The aim of this study was to determine the radiological characteristics of cerebral lesions that could predict the occurrence of postoperative ICH in IE patients. ⋯ The results suggest that the incidence of postoperative ICH in IE patients was slightly higher in the presence of preoperative cerebral infarcts. In addition, preoperative cerebral ischaemic infarcts complicated with HT tended to have a higher incidence of postoperative ICH than those not complicated with HT. However, the difference was not statistically significant. Multiple preoperative cerebral infarcts were not associated with higher incidence of postoperative ICH compared with single cerebral infarcts.
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Eur J Cardiothorac Surg · May 2016
Very long-term outcomes of the Carpentier-Edwards Perimount aortic valve in patients aged 50-65 years.
Aortic valve replacement (AVR) using a bioprosthesis remains controversial for patients aged 50-65 years. This cohort study reports the very long-term outcomes of AVR using Carpentier-Edwards Perimount pericardial bioprosthesis in this age group. ⋯ In patients aged 50-65 years undergoing AVR with the Carpentier-Edwards Perimount bioprosthesis, the expected valve durability was 19 years. Age was not a significant risk factor for SVD within this age group. Patient selection and attention to timing of reintervention may be determinants of long-term outcomes.
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Eur J Cardiothorac Surg · Apr 2016
The combined role of sinuses of Valsalva and flow pulsatility improves energy loss of the aortic valve.
Normal aortic valve opening and closing movement is a complex mechanism mainly regulated by the blood flow characteristics and the cyclic modifications of the aortic root. Our previous in vitro observations demonstrated that the presence of the Valsalva sinuses, independently from root compliance, is important in reducing systolic pressure drop across the aortic valve. This in vitro study was designed to ascertain if this effect is dependent on the flow characteristics. ⋯ These findings (i) confirm the hypothesis that the sinuses of Valsalva play a key role in optimizing the aortic haemodynamics during systole, minimizing energy losses; (ii) suggest that the sinuses of Valsalva are needed because of the complex nature of blood flow during ejection.