The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Long-term outcome of patients on continuous-flow left ventricular assist device support.
Recent advances in technology and improved patient management have enabled the use of mechanical circulatory support for unexpected long-term periods. Improved long-term outcomes may facilitate the use of device therapy as an alternative to heart transplantation. However, there are scarce data about the long-term outcomes of continuous-flow left ventricular assist devices. This study sought to evaluate the long-term outcomes in patients receiving continuous-flow left ventricular assist devices. ⋯ Current continuous-flow left ventricular assist devices can provide satisfactory long-term survival. However, rehospitalization is frequently required.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Is single-dose prophylactic gentamicin associated with acute kidney injury in patients undergoing cardiac surgery? A matched-pair analysis.
Although aminoglycoside treatment has been associated with nephrotoxic effects, single-dose gentamicin has been considered safe in surgery. However, the effect of a single-dose prophylactic aminoglycoside on the risk of acute kidney injury among patients undergoing cardiac surgery remains uncertain. ⋯ A single-dose prophylactic aminoglycoside in adult cardiac surgery patients was associated with an increased risk of acute kidney injury but not with a greater frequency of postoperative dialysis or mortality. No differences in the incidence of sternal infections between groups were observed.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Preoperative heart failure in the Medicare population undergoing mitral valve repair and replacement: an opportunity for improvement.
Elderly patients are under-represented in most surgical series of mitral valve surgery. The impact of preoperative heart failure (HF) on the outcomes of this subset has not been extensively studied. ⋯ Preoperative HF is present in a large number of elderly patients undergoing primary isolated mitral valve surgery and adversely affects their short-term and long-term survival, irrespective of procedure type (repair or replacement). The study supports the early identification of elderly patients with mitral valve disease and referral to surgery before the onset of HF.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Anatomic repair of Ebstein's anomaly with isolated anterior leaflet downward displacement.
Ebstein's anomaly with isolated anterior leaflet downward displacement is rare and has not been reported in the literature to our knowledge. In this article, our experience of the surgical treatment in 6 cases with this anomaly is reported. ⋯ Ebstein's anomaly with isolated anterior leaflet downward displacement is a complex and severe abnormality, and has several unique anatomic and clinical features and specific surgical requirements. Preoperative diagnosis can be made by clinical investigation and echocardiography. Excellent results can be achieved by anatomic correction.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Activation of canonical transient receptor potential channels preserves Ca2+ entry and endothelium-derived hyperpolarizing factor-mediated function in vitro in porcine coronary endothelial cells and coronary arteries under conditions of hyperkalemia.
Although membrane depolarization by hyperkalemia is known to reduce Ca2+ influx in endothelial cells, the mechanism by which endothelial Ca2+ channel is affected by hyperkalemia remains poorly studied. We studied the effect of hyperkalemia on canonical transient receptor potential channels, in particular canonical transient receptor potential channel 3, in modulation of endothelial intracellular Ca2+ concentration. Endothelium-derived hyperpolarizing factor-mediated function is Ca2+ dependent, and hyperkalemic cardioplegia/organ preservation solutions impair endothelium-derived hyperpolarizing factor-mediated function. We explored the role of canonical transient receptor potential channel 3 in endothelium-derived hyperpolarizing factor-mediated function and investigated whether modulation of these channels preserves endothelial Ca2+ influx and endothelium-derived hyperpolarizing factor-mediated function under the condition of hyperkalemic/cardioplegic exposure. ⋯ Canonical transient receptor potential channel 3 is involved in endothelium-derived hyperpolarizing factor-mediated function in coronary arteries. Hyperkalemia inhibited canonical transient receptor potential channel 3-mediated Ca2+ influx in endothelial cells. Canonical transient receptor potential channel activation restores Ca2+ influx suppressed by hyperkalemia and prevents dysfunction of endothelium-derived hyperpolarizing factor.