The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · May 2013
Randomized Controlled TrialPreoperative antithrombin supplementation in cardiac surgery: a randomized controlled trial.
Purified antithrombin supplementation in cardiac surgery has been suggested for the treatment of heparin resistance and the prevention of thromboembolic complications. This study is a randomized controlled trial of preoperative purified antithrombin supplementation, with the primary end point of avoiding low (<58%) postoperative antithrombin activity levels and secondary end points including avoidance of heparin resistance, clinical outcome, and safety end points. ⋯ Preoperative antithrombin supplementation prevents heparin resistance and avoids excessive postoperative decrease of antithrombin activity.
-
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
Editorial ReviewA systematic review on the quality of life benefits after aortic valve replacement in the elderly.
Surgical aortic valve replacement is being increasingly performed in elderly patients with good perioperative outcomes and long-term survival. Evidence is limited on health-related quality of life after aortic valve replacement, which is an important measure of operative success in the elderly. ⋯ Aortic valve replacement results in significant health-related quality of life benefits across a broad range of health domains in elderly patients. Age alone should not be a precluding factor for surgery. Data are heterogeneous and mostly retrospective. We recommend future studies based on consistent guidelines provided in this systematic review.
-
J. Thorac. Cardiovasc. Surg. · May 2013
Controlled Clinical TrialPrevention of poststernotomy wound infections in obese patients by negative pressure wound therapy.
The majority of wound infections after median sternotomy in obese patients are triggered by the breakdown of skin sutures and subsequent seepage of skin flora. The purpose of this study was to evaluate negative pressure wound dressing treatment for the prevention of infection. We hypothesized that negative pressure wound dressing treatment for 6 to 7 days applied immediately after skin closure reduces the numbers of wound infections. ⋯ Negative pressure wound dressing treatment over clean, closed incisions for the first 6 to 7 postoperative days significantly reduces the incidence of wound infection after median sternotomy in a high-risk group of obese patients.
-
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.