J Cardiovasc Surg
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Multicenter Study
Females do not have increased risk of early or late mortality after isolated aortic valve replacement: results from a multi-institutional Australian study.
There is controversy regarding whether isolated aortic valve replacement (AVR) in women is associated with an increased risk of early and late mortality. The current study evaluates the impact of gender as an independent risk factor for early and late mortality after isolated AVR. ⋯ Female patients undergoing isolated AVR do not have an increased risk of early and late mortality. Further investigation is required to delineate the impact of gender on early and late outcomes following AVR.
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Multicenter Study
Endovascular management of peripheral arterial trauma in patients presenting in hemorrhagic shock.
This study investigated patients who sustained peripheral arterial trauma, presented with clinical signs of shock, and underwent urgent endovascular repair (endo-R). ⋯ Endo-R of traumatic non-aortic arterial injuries or spontaneous ruptures might be considered as a treatment option-in preference to open repair-even in emergency settings such as in shock patients. However, the safety of endovascular treatment in unstable trauma patients must be proved after comparison with open surgical treatment.
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Multicenter Study Comparative Study
Influence of clinical presentation on the outcome of acute B aortic dissection: evidences from IRAD.
In-hospital outcome of acute type B dissection (ABAD) is strongly related to preoperative aortic conditions. In order to clarify the influence of the clinical presentation on the outcome, we analyzed the patients of the International Registry of Acute Aortic Dissection (IRAD). All patients affected by complicated ABAD, enrolled in the IRAD from 1996-2004, were included. Complications were defined as the presence of shock, periaortic hematoma, spinal cord ischemia, preoperative mesenteric ischemia/infarction, acute renal failure, limb ischemia, recurrent pain, refractory pain or refractory hypertension (group I). All other patients were categorized as uncomplicated (group II). A comprehensive analysis was performed of all clinical variables in relation to in-hospital outcome. ⋯ ABAD is a heterogeneous disease that produces dissimilar clinical subsets, each of which can have specific clinical signs, management and in-hospital results. In IRAD ABAD uncomplicated patients, medical therapy was associated with best hospital outcome, while endovascular interventions were associated with better results than surgery when invasive treatments were required. Although selection bias may be possible, and irrespective of treatments, knowledge of significant risk factors for mortality may contribute to a better management and a more defined risk-assessment in patients affected by ABAD.
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Randomized Controlled Trial Multicenter Study
Evaluation of the topical hemostatic efficacy and safety of TISSEEL VH S/D fibrin sealant compared with currently licensed TISSEEL VH in patients undergoing cardiac surgery: a phase 3, randomized, double-blind clinical study.
TISSEEL VH is the only commercially available fibrin sealant indicated as an adjunct to conventional methods of hemostasis during cardiac surgery. A next generation fibrin sealant (TISSEEL VH S/D) has been developed in frozen, ready-to-use form with an added virus inactivation step (solvent/detergent [S/D] treatment) to provide added safety and convenience to the currently licensed product. This study was performed to compare efficacy and safety of the two products. ⋯ TISSEEL VH S/D is safe and effective for use as an adjunct to hemostasis in patients undergoing cardiac surgery.
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Multicenter Study
Relationship of proximal fixation to renal dysfunction in patients undergoing endovascular aneurysm repair.
Technological advancements have lead to dramatic improvements in stentgraft device design resulting in more trackable delivery systems and transrenal uncovered stents and barbs for better fixation. Transrenal bare-stents may limit stentgraft migration, particularly in patients with short or flared proximal aortic necks. However, potential disadvantages might be in worsening renal function, particularly in patients with preexisting renal insufficiency. ⋯ In patients with CRI, EVAR with intra-arterial radiographic contrast agents is believed to impair renal function, and CRI is considered a relative contraindication to the procedure. Results of our investigation indicate that risk for worsening renal insufficiency, dialysis, and death is only slightly and not significantly greater in patients with CRI compared with patients with normal renal function. With appropriate precautions of avoiding perioperative hypotension and limiting the volume of nonionic contrast agents, CRI need not be a contraindication for EVAR with intra-arterial contrast agents.