The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Management of systolic anterior motion after mitral valve repair: an algorithm.
To evaluate the effectiveness and outcomes of an intraoperative and postoperative algorithm for managing systolic anterior motion (SAM) after mitral valve repair (MVRr). ⋯ SAM is a relatively frequent complication after MVRr and can occur intraoperatively or postoperatively. A systematic approach addressing perioperative SAM after MVRr yields excellent mid-term results.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Mitral and tricuspid valve repair and growth in unbalanced atrial ventricular canal defects.
Congenital mitral and tricuspid valve abnormalities in unbalanced atrioventricular canal defects are complex. We designed procedures to both repair and induce growth of hypoplastic atrioventricular valves and ventricles to achieve 2-ventricle repairs. Midterm data were assessed for reliability of catch-up growth, resulting quality of atrioventricular valves, and adequacy of 2-ventricle repairs. ⋯ Increasing atrioventricular valve flow reliably induced growth. Valve repair and growth achieved a 2-ventricle repair in all patients.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
The effect of surgeon volume on mortality for off-pump coronary artery bypass grafting.
Recent trials comparing on-pump (CABG) with off-pump coronary artery bypass grafting (OPCAB) have been criticized by those who believe that surgeon inexperience may explain the apparent worse outcomes for OPCAB. However, the true effect of surgeon volume on outcomes after OPCAB remains unknown. The purpose of this study was to examine the effect of surgeon volume on risk-adjusted mortality after OPCAB. ⋯ A significant surgeon volume-outcome relationship exists for mortality after OPCAB with a threshold of more than 50 operations per year. However, the contribution of surgeon volume to the probability of death is incrementally small compared with other patient and operative characteristics. This demonstrates that outcomes after OPCAB are more dependent on patient risk factors than on surgeon volume.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Mitral valve annuloplasty and papillary muscle relocation oriented by 3-dimensional transesophageal echocardiography for severe functional mitral regurgitation.
The study of the mitral valve apparatus and its modifications during functional mitral regurgitation (FMR) is better revealed by 3-dimensional (3D) transesophageal echocardiography (TOE). To plan mitral valve repair by annuloplasty and papillary muscle (PPM) relocation, we proposed a valve repair procedure oriented by the new main features obtained by real-time 3D TOE reconstruction of the mitral valve apparatus. ⋯ PPM relocation plus ring annuloplasty reduce mitral valve tenting and may improve mitral valve repair results for patients with severe FMR. This technique may be easily and precisely guided by preoperative offline 3D echocardiographic mitral valve reconstruction.
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J. Thorac. Cardiovasc. Surg. · Apr 2012
Does donor arterial partial pressure of oxygen affect outcomes after lung transplantation? A review of more than 12,000 lung transplants.
In lung transplantation (LTx), the arterial partial pressure of oxygen (PaO(2)) is traditionally regarded as critical information for assessment of donor lung function. Each center sets its own thresholds; by convention, a donor PaO(2) of less than 300 mm Hg has been considered disqualifying. Limited literature exists to support such a practice. We analyzed all LTxs performed in the United States over a 9-year period to assess the effect of donor PaO(2) on graft survival. ⋯ Donor PaO(2) levels did not affect graft survival. The use of donors with lower PaO(2)s could substantially increase the donor pool. We are not suggesting that donor PaO(2) is not important when assessing potential lung donors but its level of importance in regard to other criteria appears less than previously believed.