The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 2009
Warm-blood cardioplegic arrest induces selective mitochondrial translocation of protein kinase Cepsilon followed by interaction with 6.1 inwardly rectifying potassium channel subunit in viable myocytes overexpressing urocortin.
This study investigates the cardioprotective role and mechanism of action of urocortin in patients undergoing cardiac surgery, with respect to protein kinase Cepsilon expression, activation, and relocation. ⋯ After iatrogenic ischemia/reperfusion injury, urocortin expression in viable cells selectively colocalized with enhanced phosphorylation and mitochondrial relocation of protein kinase Cepsilon, suggesting a cardioprotective role for endogenous urocortin. The physical interaction of activated protein kinase Cepsilon with 6.1 inwardly rectifying potassium channel, enhanced by cardioplegic arrest, may represent a conjectural mechanism of urocortin-mediated cardioprotection.
-
J. Thorac. Cardiovasc. Surg. · Nov 2009
Multicenter StudySelective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery.
Selective antegrade cerebral perfusion is a well-described neuroprotective technique used in proximal aortic surgery. This study investigated whether selective antegrade cerebral perfusion is associated with improved outcomes in both emergency and elective settings compared with deep hypothermic circulatory arrest alone. ⋯ Use of selective antegrade cerebral perfusion confers a survival advantage during proximal aortic surgery that is most apparent in the elective setting. Improved resource utilization and fewer pulmonary and renal complications were observed in patients with selective antegrade cerebral perfusion.
-
J. Thorac. Cardiovasc. Surg. · Nov 2009
Improved management of systemic venous anomalies in a single ventricle: New rationale.
Two innovative surgical approaches addressing systemic venous anomalies in single-ventricle patients are evaluated. ⋯ This limited clinical and computational fluid dynamics assessment suggests the efficacy of this new rationale to reduce the additional thrombotic risks produced by systemic venous anomalies in single-ventricle patients.
-
J. Thorac. Cardiovasc. Surg. · Nov 2009
Is transapical aortic valve implantation really less invasive than minimally invasive aortic valve replacement?
Transcatheter valve implants currently draw their justification for use from reduction of perioperative risk. However, patient age and comorbidities are independent predictors of adverse outcome after aortic valve replacement, regardless of surgical approach. Therefore, it is unclear whether transapical aortic valve implantation really improves outcomes in high-risk patients. ⋯ Current data suggest a faster postoperative recovery after transapical aortic valve implantation, with early and late morbidity and mortality comparable with those of minimally invasive aortic valve replacement via partial upper sternotomy.
-
J. Thorac. Cardiovasc. Surg. · Nov 2009
Migration forces of transcatheter aortic valves in patients with noncalcific aortic insufficiency.
Transcatheter aortic valves have been successfully implanted into the calcified leaflets of patients with severe aortic stenosis. However, their stability in patients with noncalcified aortic insufficiency is unknown. Similar to thoracic and abdominal aortic stent grafts, transcatheter aortic valves are subjected to antegrade ejection forces during systole. However, retrograde migration forces into the left ventricle are also generated by the diastolic pressure gradient across the closed valve. It has been suggested that leaflet calcification anchors the prosthesis, and measurements of migration forces should be considered before clinical trials in noncalcified aortic insufficiency. The objective of this study was to use computational fluid dynamics simulations to quantify forces that could potentially dislodge the prosthesis. ⋯ Our model simulated systolic flow through a transcatheter aortic valve and demonstrated migration into the left ventricle to be of greater concern than antegrade ejection.