The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Surgery for acute aortic dissection using the Chinese CRONUS stented elephant trunk technique: experience with 252 patients.
The elephant trunk method was introduced to treat aortic disease. There are a variety of modified elephant trunk methods, including the stented elephant trunk. We retrospectively reviewed our experience and evaluated the effectiveness of surgical treatment for acute aortic dissection using the Chinese CRONUS stented elephant trunk technique. ⋯ In surgery for acute aortic dissection, the Chinese CRONUS stented elephant trunk technique had a low prevalence of morbidity and mortality in our patients. The satisfactory effects demonstrated that the technique is safe and effective in closing the residual false lumen of the descending aorta. Stented elephant trunk fenestration could further simplify the surgical procedure with minimal invasion.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Comparative StudyLongevity after mechanical aortic root replacement--do men live longer?
To investigate whether longevity after mechanical aortic root replacement is influenced by the patient's gender. ⋯ Overall, long-term survival after mechanical aortic root replacement was significantly better among men. However, comparing age-matched subgroups≤55 years old, no significantly different life expectancy was found after mechanical root replacement.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Toward zero: deep sternal wound infection after 1001 consecutive coronary artery bypass procedures using arterial grafts: implications for diabetic patients.
Coronary artery bypass graft (CABG) surgery with arterial conduits is considered optimal. A deterrent to bilateral internal thoracic artery (BITA) grafting is the risk of deep sternal wound infection (DSWI). We introduced infection prevention measures sequentially, attempting to reduce DSWIs. The aim was to determine (1) if the absence of DSWIs in the last 469 of 1001 consecutive operations was significant; (2) which measures explained the change; and (3) the impact of diabetes. ⋯ The measures applied caused a substantial reduction in DSWIs. Key measures included the use of chlorhexidine-alcohol and avoidance of BITA grafting in obese diabetic females. These measures reduced DSWIs after BITA grafting in most diabetics.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment.
This study examined the outcomes of surgery for active prosthetic valve endocarditis in a recent decade, with special interest in preoperative treatment and predictors for early and late events. ⋯ Cardiac and renal function, need for double valve replacement, and preoperative treatment predicted outcomes. A prolonged interval in which patients were left untreated while symptomatic, but not prolongation of preoperative antibiotic treatment, increased risk.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Multicenter StudyChronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: long-term angiographic results of 2 different revascularization strategies.
To compare 2 different surgical approaches to treatment of patients with isolated predivisional stenosis of the left main coronary artery (IOSLM) and to evaluate the effect of chronic competitive flow from a patent arterial or venous graft to the circumflex system on the long-term patency of internal thoracic artery (ITA) to left anterior descending grafts. ⋯ In patients with IOSLM, long-term ITA to left anterior descending artery patency is not jeopardized by chronic flow competition from a concomitant arterial or venous graft to the circumflex system. Notably, the addition of a second ITA graft or of a SV to the first ITA does not lead to differences in long-term angiographic patency. Our results minimize the role of flow competition in this setting and should be kept in mind when choosing the appropriate graft configuration.