The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Medical errors: the performance gap in hypoplastic left heart syndrome and physiologic equivalents?
The frequency and impact of medical errors during staged palliation are unknown. ⋯ Technical errors are common and delay recovery. Their effects on survival are mitigated. Intraoperative judgment errors are associated with strategy failure in a univariate model and lead to increased postoperative errors in a multivariate model. Postoperative errors are independently associated with a decrease in univentricular strategy survival.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Clampless technique during coronary artery bypass grafting for proximal anastomoses in the hostile aorta.
The incidence of stroke in patients undergoing coronary artery bypass grafting increases sharply in the face of significant atherosclerotic disease of the ascending aorta. We use a technique that allows full revascularization for this cohort of patients, while minimizing cerebral embolic risk. ⋯ We have found that clampless fibrillating heart surgery with circulatory arrest for proximal anastomoses is a safe and effective technique for revascularizing patients with significant ascending aortic disease who are at high risk for cerebral embolic complications.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Sealing of pulmonary arteries with LigaSure: in vivo and ex vivo examinations.
The LigaSure device has been demonstrated to be safe for systemic vessels up to 7 mm in diameter, although its use in thoracic surgery remains understudied. We aimed to evaluate the safety of LigaSure for pulmonary artery sealing. ⋯ LigaSure does not result in complete fusion of the wall layers of pulmonary arteries. The pulmonary artery burst pressure after sealing is significantly less compared with conventional suture ligation. It remains unclear whether these findings create a clinical risk of rupture.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Fetal cardiac intervention: improved results of fetal cardiac bypass in immature fetuses using the TinyPump device.
Fetal cardiac surgery is a potential innovative treatment for certain congenital heart defects that have significant mortality and morbidity in utero or after birth, but it has been limited by placental dysfunction after fetal cardiac bypass. We have used the TinyPump device for fetal cardiac bypass in sheep fetuses at 90 to 110 days gestation. ⋯ We demonstrate the feasibility of the TinyPump device for fetal cardiac bypass in a fetal sheep model. The TinyPump group showed improved results compared with the roller head group despite more immature fetuses. The TinyPump device seems to be a promising device for future studies of fetal cardiac bypass in immature fetal sheep and in primates.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
New ascending aortic aneurysm model in rats reproduces main structural features of degenerative ascending thoracic aortic aneurysms in human beings.
The singularity of the ascending aorta regarding mechanisms driving aneurysm formation requires the development of specific animal models. We investigated if adventitial elastase application results in ascending aorta aneurysms in rats. ⋯ Elastase application on rat ascending aortic adventitia produced aneurysms, creating a reproducible model. Aortic wall remodeling evolved toward an increase in total wall area, reproducing the main structural features of this disease in human beings.