The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Hemi-aortic arch debranching for hybrid aortic arch repair by sequential transposition of the left common carotid and subclavian arteries.
The aim of this study was to assess the short-term and midterm results after hemi-aortic arch debranching for hybrid aortic arch repair by sequential transposition of the left common carotid artery and of the left subclavian artery. ⋯ Hybrid aortic arch repair by sequential transposition of the left common carotid artery and of the left subclavian artery for zone 1 lesions provides an attractive alternative for treating hemi-aortic arch lesions in high-risk patients with minimal atherosclerotic disease in the aorta and great vessels with acceptable primary results and encouraging midterm efficacy to prevent rupture. This hybrid strategy avoiding prosthetic bypass offers several advantages over conventional repair, including the potential to treat patients who are not candidates for open repair and single-stage treatment of some pathologic conditions previously requiring 2-stage repair.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Innominate artery cannulation: an alternative to femoral or axillary cannulation for arterial inflow in proximal aortic surgery.
To evaluate the effectiveness of innominate artery cannulation in proximal aortic procedures, including those involving hypothermic circulatory arrest. ⋯ Cannulating the innominate artery for arterial inflow is an alternative technique for proximal aortic surgery procedures. It is especially useful in cases requiring hypothermic circulatory arrest to deliver antegrade cerebral perfusion.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Tirone David valve-sparing aortic root replacement and cusp repair for bicuspid aortic valve disease.
The durability of valve-sparing aortic root replacement with or without cusp repair in patients with bicuspid aortic valve (BAV) disease is questioned. We analyzed the results of 75 patients with a BAV undergoing Tirone David reimplantation valve-sparing aortic root replacement. ⋯ After David procedure and cusp repair in patients with a BAV, midterm clinical and valve function outcomes were favorable out to 6 years. More follow-up is required to determine long-term valve durability and the hazard of other clinically important late adverse events, including eventual reoperation, to beyond 10 years.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair.
With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. ⋯ Conventional open arch repair yielded satisfactory outcomes and should remain the standard therapy, with good long-term durability in all but high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Multicenter StudyPrioritizing quality improvement in pediatric cardiac surgery.
Several efforts are under way to conduct quality-improvement initiatives in pediatric cardiology and cardiac surgery. Our goal was to develop an objective prioritization scheme for such initiatives based on encounter frequency and relative contribution of quality measures of morbidity (and associated variances), particularly in the setting of low mortality. ⋯ A small number of procedures account for a substantial burden of morbidity, even among low mortality risk groups. Consideration should be given to using such objective prioritization schemes to develop targeted quality-improvement measures.