The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Is there a need for adjunct cerebral protection in conjunction with deep hypothermic circulatory arrest during noncomplex hemiarch surgery?
Different cerebral protection strategies are currently being practiced during noncomplex hemiarch surgery without randomized control studies to show their relative efficacy. We hypothesized that deep hypothermic circulatory arrest (DHCA) alone was adequate for cerebral protection in noncomplex hemiarch surgery. ⋯ Outcomes and survival using DHCA alone were comparable to adjunct cerebral protection methods in patients undergoing noncomplex hemiarch surgery. DHCA alone is as safe as other adjunct complex cerebral protection techniques and simplifies operation without additional risk.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Open aortic arch reconstruction after previous cardiac surgery: outcomes of 168 consecutive operations.
Open arch interventions after previous cardiac surgery are considered high risk. We reviewed our outcomes in patients requiring aortic arch reconstruction after previous cardiovascular surgery. ⋯ Reoperations to address the aortic arch have acceptable mortality and morbidity. Open repair under circulatory arrest is the benchmark to which endovascular therapies should be compared.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Uncovered stent implantation in complicated acute aortic dissection type B.
To retrospectively evaluate the technical feasibility and midterm results of uncovered thoracoabdominal stent placement in complicated acute aortic dissection Stanford type B (cAADB). ⋯ Acute aortic dissection with suspicion of visceral ischemia should prompt for immediate intervention. Thoracoabdominal uncovered stent implantation is a technically feasible and effective minimally invasive approach that provided successful relief of acute visceral ischemia and claudication in cAADB. Stent size should be less than the normal aortic diameter to avoid possible stent collapse.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Observational StudyTransapical aortic valve implantation in patients with poor left ventricular function and cardiogenic shock.
In line with our institutional no exclusion policy we accept patients with very poor left ventricular performance and cardiogenic shock for transcatheter aortic valve implantation (TAVI). The purpose of our study was to analyze outcome in these patients and to identify what happens to the left ventricular function after TAVI in patients with failing ventricles. ⋯ In the majority of patients with failing ventricles, left ventricular function is quickly restored after TAVI and elimination of aortic stenosis. Without the additional trauma of cardioplegic arrest, TAVI is the potentially superior treatment option in patients with poor and very poor left ventricular performance.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Autogenous rib grafts for reconstruction of the manubrium after resection: technical refinements and outcomes.
Sternal reconstruction after resection is essential for restoring the rigidity of the chest cavity. However, no consensus has been reached regarding the most physiologic or efficacious material for this procedure. We present our clinical experience with autogenous rib grafts for reconstruction of the manubrium after resection and discuss the refinements in this procedure. ⋯ This case series demonstrates the successful use of autogenous rib grafts in the reconstruction of the manubrium after resection. We consider that the reconstruction technique is a safe and effective alternative to a complex problem.