The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Comparative StudyAge cutoff for the loss of survival benefit from use of radial artery in coronary artery bypass grafting.
Controversy still exists about the superiority of the radial artery (RA) over the saphenous vein graft (SVG) as a second conduit for surgical myocardial revascularization. We aimed to investigate the presence of any survival benefit from use of the RA and relate it to patients' age. ⋯ The use of the radial artery graft as a second conduit improves all-cause mortality in patients undergoing primary isolated CABG up to the age of 70 years.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Assessment of coronary artery disease risk in 5463 patients undergoing cardiac surgery: when is preoperative coronary angiography necessary?
We sought to critically analyze the routine use of conventional coronary angiography (CCA) before noncoronary cardiac surgery and to assess clinical prediction models that might allow more selective use of CCA in this setting. ⋯ In the absence of angina, previous myocardial infarction, or percutaneous coronary intervention, preoperative CCA identified significant CAD in only one third of patients. Our clinical prediction models could enhance the identification of patients at low risk of significant CAD for whom CCA might potentially be avoided before cardiac surgery. This strategy may improve the efficiency of cardiac surgical care delivery by diminishing procedure-related morbidity and offering significant cost savings.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Observational StudyTricuspid regurgitation and right ventricular function after mitral valve surgery with or without concomitant tricuspid valve procedure.
To study the effect of mitral valve repair with or without concomitant tricuspid valve repair on functional tricuspid regurgitation and right ventricular function. ⋯ In patients with mitral valve disease and severe tricuspid regurgitation, mitral valve repair alone was associated with improved tricuspid regurgitation and right ventricular function. However, the improvements were incomplete and temporary. In contrast, concomitant tricuspid valve repair effectively and durably eliminated severe tricuspid regurgitation and improved right ventricular function toward normal, supporting an aggressive approach to important functional tricuspid regurgitation.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio.
The aim of this study was to determine the influence of aortic annulus (AA) diameter and the ratio of the sinotubular junction (STJ) diameter to the AA diameter on aortic valve hemodynamics and tissue mechanics and to suggest optimal values. ⋯ Relatively large coaptation, low stress in the tissues during diastole, and low flow shear stress during systole is the best combination for cases of AA diameter between 24 and 26 mm with identical STJ diameter. Valve-sparing procedures that prevent AA expansion are preferable.
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J. Thorac. Cardiovasc. Surg. · Nov 2013
Rapid 2-stage Norwood I for high-risk hypoplastic left heart syndrome and variants.
Preoperative comorbidities (PCMs) are known risk factors for Norwood stage I (NW1). We tested the hypothesis that short-term bilateral pulmonary arterial banding (bPAB) before NW1 could improve the prognosis of these high-risk patients. ⋯ Optimizing the balance between the pulmonary and systemic blood flow with a short period of bPAB and ductal patency can improve the perioperative conditions of high-risk patients before NW1. Those who survived bPAB and underwent NW1 had early mortality and 1-year survival comparable to the standard risk category, despite the severity of their initial condition. A rapid 2-stage NW1 strategy with bPAB and prostaglandin to maintain ductal patency can avoid the risks of suboptimal palliation and vascular injuries associated with hybrid procedures.