The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2009
Comparative StudyAnalysis of the US Food and Drug Administration Manufacturer and User Facility Device Experience database for adverse events involving Amplatzer septal occluder devices and comparison with the Society of Thoracic Surgery congenital cardiac surgery database.
Amplatzer (AGA Medical Corporation, Plymouth, Minn) septal and vascular occluder devices have significantly altered the care of patients with congenital heart disease. The relative frequency and consequence of complications resulting from the attempted placement of such devices, however, have not been well assessed. The purpose of this study is to use large databases to assess the frequency and severity of such complications and compare them with those of surgical atrial septal defect closure. ⋯ Overall crude mortality for device and surgical closure atrial septal defect closure is equivalent, and the need for subsequent operation (surgical rescue) is more common in patients undergoing device closure than reoperation is in patients undergoing surgical closure. Complications from device closure tend to be serious and most often require urgent or emergency operative management, whereas the mortality for surgical management of a device complication appears higher than that of elective atrial septal defect closure. Further information is required in the form of postmarketing surveillance, such as a mandatory user registry with periodic end-user notification.
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J. Thorac. Cardiovasc. Surg. · Jun 2009
Open distal anastomosis in aortic root replacement using axillary cannulation and moderate hypothermia.
Recent advance in surgical technique facilitates more aggressive approaches for thoracic aortic diseases. We sought to address the outcomes of our strategy of open distal anastomosis with aortic root replacement using axillary cannulation and moderate hypothermia. ⋯ Open distal anastomosis at the time of aortic root replacement can safely be performed with axillary artery cannulation and moderate hypothermia. Axillary cannulation provides a reliable route of antegrade cerebral perfusion and enables the complex procedure to be performed without deep hypothermic circulatory arrest.
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J. Thorac. Cardiovasc. Surg. · Jun 2009
Cardiovascular surgery in children with Marfan syndrome or Loeys-Dietz syndrome.
This study was undertaken to assess the frequency and outcome of cardiovascular surgery in children with Marfan or Loeys-Dietz syndrome. ⋯ Patients with Marfan or Loeys-Dietz syndrome requiring surgery during childhood have a favorable long-term outcome. Those undergoing valve-sparing root replacement or mitral valve repair have a low risk for reoperation. Postoperative angiotensin-converting enzyme inhibitor therapy confers clinical benefit.
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J. Thorac. Cardiovasc. Surg. · Jun 2009
Randomized Controlled Trial Multicenter StudyImpact of preconditioning protocol on anesthetic-induced cardioprotection in patients having coronary artery bypass surgery.
Anesthetic preconditioning may contribute to the cardioprotective effects of sevoflurane in patients having coronary artery bypass surgery. We investigated whether 2 different sevoflurane administration protocols can induce preconditioning in patients having coronary artery bypass. ⋯ These data show that sevoflurane-induced preconditioning is reproducible in patients having coronary artery bypass but depends on the preconditioning protocol used.
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J. Thorac. Cardiovasc. Surg. · Jun 2009
Prolonged venoarterial extracorporeal membrane oxygenation after transplantation restores functional integrity of severely injured lung allografts and prevents the development of pulmonary graft failure in a pig model.
Prolonged venoarterial extracorporeal membrane oxygenation support during transplantation provides reduction of pulmonary artery flow and allows for protective ventilation. This approach might have the potential to restore function of lungs that would be unsuitable for transplantation. ⋯ Transplantation during extracorporeal membrane oxygenation with continued use for 24 hours restores function of damaged donor lungs. This could expand the donor pool through wider use of marginal donors.