The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · May 2013
Plasma biomarkers for distinguishing etiologic subtypes of thoracic aortic aneurysm disease.
Thoracic aortic aneurysms (TAAs) develop through an asymptomatic process resulting in gross dilation that progresses to rupture if left undetected and untreated. If detected, patients with TAA are followed over time until the risk of rupture outweighs the risk of surgical repair. Current methodologies for tracking TAA size are limited to expensive computed tomography or magnetic resonance imaging because no acceptable population screening tools are currently available. Previous studies from this laboratory and others have identified differential protein profiles for the matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs), in ascending TAA tissue from patients with bicuspid aortic valves (BAVs), versus patients with idiopathic degenerative disease and a tricuspid aortic valve (TAV). In addition, altered microRNA (miR) expression levels have also been reported in TAAs compared with normal aortic tissue. The objective of our study was to identify circulating factors within plasma that could serve as potential biomarkers for distinguishing etiologic subtypes of aneurysm disease. ⋯ Taken together, these unique data demonstrate differential plasma profiles of MMPs, TIMPs, and miRs in ascending TAA specimens from patients with BAV and TAV. These results suggest that circulating biomarkers may form the foundation for a broader platform of biomarkers capable of detecting the presence of TAA using a simple blood test and may also be useful in personalized strategies to distinguish between etiologic subtypes of TAAs in patients with aneurysm disease.
-
J. Thorac. Cardiovasc. Surg. · May 2013
Use of continuous flow ventricular assist devices in patients with heart failure and a normal ejection fraction: a computer-simulation study.
Continuous flow left ventricular assist devices are used in end-stage systolic heart failure. However, about one half of the patients with heart failure exhibit diastolic dysfunction with a normal ejection fraction. In the present study, the possible hemodynamic consequences of continuous flow left ventricular assist devices use for these patients were investigated. ⋯ The simulation results suggested that continuous flow left ventricular assist devices improve the hemodynamics in patients with heart failure and a normal ejection fraction. For an optimal use of continuous flow left ventricular assist devices, low speeds should be maintained at rest, to avoid suction. However, during physical activity, higher speeds are needed to prevent an abnormal increase in the ventricular filling pressures typical of patients with heart failure and a normal ejection fraction.
-
J. Thorac. Cardiovasc. Surg. · May 2013
Comparative StudyCryoablation during left ventricular assist device implantation reduces postoperative ventricular tachyarrhythmias.
The number of patients undergoing implantation of a HeartMate II left ventricular assist device (LVAD; Thoratec Corporation, Pleasanton, Calif) is rising. Ventricular tachyarrhythmia (VA) after placement of the device is common, especially among patients with preoperative VA. We sought to determine whether intraoperative cryoablation in select patients reduces the incidence of postoperative VA. ⋯ Postoperative VA can be minimized by preoperative risk assessment and intraoperative treatment. Localized cryoablation in select patients offers promising early feasibility when performed during HeartMate II LVAD implantation. Further prospective analysis is required to investigate this novel approach.
-
J. Thorac. Cardiovasc. Surg. · May 2013
Comparative StudyClinical outcome score predicts the need for neurodevelopmental intervention after infant heart surgery.
Our goal was to determine if a clinical outcome score derived from early postoperative events is associated with 18- to 24-month Psychomotor Developmental Index (PDI) score among infants undergoing cardiopulmonary bypass surgery. ⋯ Clinical outcome scores of ≥3 were associated with a significantly lower PDI at age 18 to 24 months. This score may be valuable as an end point when evaluating novel potential therapies for this high-risk population.
-
J. Thorac. Cardiovasc. Surg. · May 2013
Comparative StudyRight anterior minithoracotomy versus conventional aortic valve replacement: a propensity score matched study.
Minimally invasive aortic valve surgery by way of a right anterior minithoracotomy has shown excellent results in terms of mortality, morbidities, and patient satisfaction. The aim of the present study was to compare minimally invasive aortic valve surgery by way of a right anterior minithoracotomy with conventional full sternotomy on early outcomes and midterm survival. ⋯ Right anterior minithoracotomy in patients undergoing isolated aortic valve surgery is associated with a lower incidence of postoperative atrial fibrillation and blood transfusion and shorter ventilation time and hospital length of stay. Prospective randomized trials are needed to confirm our data.