Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Comparative StudyThe Clinical Significance of Cerebral Microbleeds in Infective Endocarditis Patients.
We assessed the clinical features of cerebral microbleeds (CMBs) and their association with clinical outcomes in active infective endocarditis patients. From January 2009 to June 2015, 132 active IE patients diagnosed per the modified Duke's criteria were retrospectively reviewed. Brain magnetic resonance imaging was performed in 102 patients, and 74 patients whose image data were available to assess CMBs were enrolled. ⋯ Cox regression analysis adjusting age and operative risk did not show that CMB was a significant risk factor for all-cause death and major adverse event. Patients with CMB were older than those without, and microbleeds were associated with antiplatelet therapy, staphylococcal infection, and prosthetic valve endocarditis. However, the mid-term clinical outcomes of patients with CMB and those without were comparable.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Case ReportsPartition of Common Atrioventricular Valve in a Patient With Dextrocardia and Univentricular Circulation.
Long-term outcomes in children with atrioventricular septal defect (AVSD) and univentricular palliation are of concern, with <60% survival at 25 years.1 Common atrioventricular valves (AVV) often become insufficient in patients with univentricular physiology, leading to heart failure.1,2 We have recently observed that outcomes of children with AVSD who reach Fontan circulation are not as bad as previously thought, provided that the AVV remains competent.1 Common AVV surgery is associated with substantial mortality and reoperation rates.3 Although successful AVV repair is associated with better survival and freedom from reoperation, good quality repair is difficult to achieve in univentricular circulation,3 especially in patients with dextrocardia.4 Herein, we report a patient with unbalanced AVSD and dextrocardia who underwent AVV repair using the "polytetrafluoroethylene (Gore-Tex, W. L. Gore & Associates, Flagstaff, AZ) bridge" technique5 with excellent early outcome.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Observational StudyPectoral Muscle Atrophy After Axillary Artery Cannulation for Aortic Arch Surgery.
To investigate postoperative pectoral atrophy in 141 patients undergoing aortic arch surgery involving bilateral axillary artery cannulations with side grafts. The depth from the skin to the axillary artery surrounding the thoracoacromial artery (zone 1), and the thicknesses of pectoralis major (zone 2) and pectoralis minor (zone 3) were measured by computed tomography before surgery, at 1 and 6 months after surgery, and at the most recent follow-up assessment (PostT2) (mean = 41 months, range 11-75 months). Based on the median value (47.4 mm) of zone 1, the preoperative pectoral thickness was categorized into 2 groups: pectoral thickness >47.4 mm (thick group) and ≤47.4 mm (thin group). ⋯ Postoperative pectoral atrophy progressed rapidly. The preoperative pectoral size might be of no use in the prevention of pectoral atrophy. Further investigation to prevent the pectoral atrophy is needed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
ReviewSurgery for Acute Presentation of Thoracoabdominal Aortic Disease.
Thoracoabdominal aortic aneurysms are most commonly asymptomatic until there is either an impending aortic catastrophe or one that has already occurred. While open surgery remains the gold-standard method for repair, modern technology has led to the development of less invasive endovascular devices and techniques. We provide an expert review of open and endovascular therapies for 3 highly lethal thoracoabdominal aortic emergencies in order to highlight expectations for both short- and long-term outcomes in an era of evolving technology and improvements in patient evaluation and postoperative care. ⋯ Thoracic endovascular aortic repair is well-suited for the treatment of acute complicated type B aortic dissection with outcomes superior to open repair in some centers. Acute aortic events associated with thoracoabdominal aneurysms represent technically challenging situations that require rapid diagnosis and treatment to avoid a fatal outcome. Endovascular techniques have evolved as a viable alternative therapy for acute complicated type B aortic dissection or as a bridge to more definitive repair in the setting of infection or rupture.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Descending Aortopexy and Posterior Tracheopexy for Severe Tracheomalacia and Left Mainstem Bronchomalacia.
Posterior descending aortopexy can relieve posterior intrusion of the left mainstem bronchus that may limit the effectiveness of posterior tracheobronchopexy. We review outcomes of patients undergoing both descending aortopexy and posterior tracheopexy for severe tracheobronchomalacia with posterior intrusion and left mainstem compression to determine if there were resolution of clinical symptoms and bronchoscopic evidence of improvement in airway collapse. All patients who underwent both descending aortopexy and posterior tracheopexy from October 2012 to October 2016 were retrospectively reviewed. ⋯ Total tracheomalacia scores improved significantly (P < 0.001), with significant segmental improvements in the middle (P = 0.003) and lower (P < 0.001) trachea, and right (P = 0.011) and left (P < 0.001) mainstem bronchi. Two patients (6%) had persistent airway intrusion requiring reoperation with anterior aortopexy or tracheopexy. Descending aortopexy and posterior tracheopexy are effective in treating severe tracheobronchomalacia and left mainstem intrusion with significant improvements in clinical symptoms and degree of airway collapse on bronchoscopy.