The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Oct 2014
Improving interstage survival after Norwood operation: outcomes from 10 years of home monitoring.
Infants who undergo Norwood stage 1 palliation (S1P) continue with high-risk circulation until stage 2 palliation (S2P). Routine care during the interstage period is associated with 10% to 20% mortality. This report illustrates the sustained reduction of interstage mortality over 10 years associated with use of home monitoring. ⋯ Home monitoring after S1P is associated with excellent interstage survival. Although a breach of monitoring criteria occurred in more than half of patients, our analysis failed to identify independent predictors of interstage events. Analysis of variables predicting mortality could not be assessed due to the low frequency of death in this cohort. Failure to identify specific variables for interstage events suggests that home monitoring, as part of an interstage surveillance program, should be applied to all S1P hospital survivors.
-
J. Thorac. Cardiovasc. Surg. · Oct 2014
Congestive hepatopathy after Fontan operation and related factors assessed by transient elastography.
Congestive hepatopathy after a Fontan operation can have a major effect on long-term morbidity. We evaluated congestive hepatopathy in patients with Fontan circulation using transient elastography to determine which risk factors for hepatopathy are related to liver stiffness (LS). ⋯ The present study revealed that congestive hepatopathy developed in a significant fraction of patients with long-term Fontan circulation and that transient elastography could be an easy and useful method to assess congestive hepatopathy in these patients.
-
J. Thorac. Cardiovasc. Surg. · Oct 2014
Mitral valve repair versus replacement in the elderly: short-term and long-term outcomes.
To compare the short-term and long-term outcomes of mitral valve repair (MVP) versus mitral valve replacement (MVR) in elderly patients. ⋯ Elderly patients with mitral regurgitation who undergo MVP have better postoperative outcomes, lower operative mortality, and improved long-term survival than those undergoing MVR. MVP is a safe and more effective option for the elderly with mitral regurgitation.
-
J. Thorac. Cardiovasc. Surg. · Oct 2014
Is routine rapid-staged bilateral pulmonary artery banding before stage 1 Norwood a viable strategy?
We adopted a policy of rapid-staged bilateral pulmonary artery banding (bPAB) before the Norwood (NW) procedure for all patients with hypoplastic left heart syndrome. We hypothesized that this strategy might mitigate some of the traditional risk factors and that postponing a major bypass procedure beyond the newborn period could have both short- and long-term benefits. The purpose of the present study was to evaluate the efficacy of this strategy with respect to the short-term outcomes. ⋯ These data suggest that rapid-staged bPAB before NW can reduce the challenge of postoperative management in the early postoperative period after the NW procedure and have potential to improve the outcomes.
-
J. Thorac. Cardiovasc. Surg. · Oct 2014
Minimally invasive mitral valve repair in Barlow's disease: early and long-term results.
Barlow's disease remains a challenging surgical pathology in patients presenting with mitral regurgitation. We reviewed our early and long-term results for patients with Barlow's disease who underwent minimally invasive mitral valve surgery. ⋯ A wide variety of repair techniques can be used to perform successful minimally invasive mitral valve repair in the majority of patients with Barlow's disease, with good early and long-term results.