The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jul 2010
Multicenter StudyPost-cardiac transplant survival after support with a continuous-flow left ventricular assist device: impact of duration of left ventricular assist device support and other variables.
Although left ventricular assist devices (LVADs) are associated with excellent outcomes in patients with end-stage heart failure, there are conflicting reports on posttransplant survival in these patients. Furthermore, prior studies with pulsatile LVADs have shown that transplantation, either early (<6 weeks) or late (>6 months) after LVAD implantation, adversely affected post-cardiac transplant survival. We sought to determine factors related to posttransplant survival in patients supported with continuous-flow LVADs. ⋯ Post-cardiac transplant survival in patients supported with continuous-flow devices such as the HeartMate II LVAD is equivalent to that with conventional transplantation. Furthermore, posttransplant survival is not influenced by the duration of LVAD support. The improved durability and reduced short- and long-term morbidity associated with the HeartMate II LVAD has reduced the need for urgent cardiac transplantation, which may have adversely influenced survival in the pulsatile LVAD era. This information may have significant implications for changing the current United Network for Organ Sharing criteria regarding listing of heart transplant candidates.
-
J. Thorac. Cardiovasc. Surg. · Jul 2010
Comparative StudyQuality of mitral valve repair: median sternotomy versus port-access approach.
We sought to compare early and late clinical and echocardiographic outcomes of patients undergoing minimally invasive mitral valve repair by means of the port-access and median sternotomy approaches. ⋯ In isolated posterior mitral valve pathology, quality of mitral valve repair with the port-access approach can compare with that with the conventional median sternotomy approach.
-
J. Thorac. Cardiovasc. Surg. · Jul 2010
Effect of beta-blocker use on outcomes after discharge in patients who underwent cardiac surgery.
Beta-blockers improve outcomes in patients with heart failure or a history of myocardial infarction, but it remains uncertain whether they are beneficial after the perioperative period in cardiac surgery patients without these conditions. This study was designed to examine whether discharge use of beta-blockers was associated with outcomes after hospitalization in patients who had undergone nontransplant cardiac surgery. ⋯ Patients discharged with beta-blockers after cardiac surgery exhibit a substantially lower mortality rate during long-term follow-up, even among those without a history of myocardial infarction or heart failure.
-
J. Thorac. Cardiovasc. Surg. · Jul 2010
Comparative StudyDouble-bar application decreases postoperative pain after the Nuss procedure.
This biomechanical study aims to elucidate whether additional bar application increases postoperative pain after the Nuss procedure for pectus excavatum. ⋯ Performing double-bar placement decreases postoperative pain. Therefore, surgeons should not hesitate to perform double-bar correction in patients in whom the deformity extends to multiple intercostal spaces, requiring correction of the thorax shape at multiple sites.
-
J. Thorac. Cardiovasc. Surg. · Jul 2010
Mortality after coronary artery revascularization of patients with rheumatoid arthritis.
Patients with rheumatoid arthritis have an increased risk for accelerated atherosclerosis. It is not known, however, whether this disorder is associated with a higher risk of complications after coronary artery revascularization. ⋯ Among patients undergoing coronary artery revascularization, patients with rheumatoid arthritis have an in-hospital survival advantage along with reduced days of hospitalization compared with patients without rheumatoid arthritis.