The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Systolic anterior motion of the mitral valve: a 30-year perspective.
Systolic anterior motion (SAM) can occur after mitral valve repair (MVr), most frequently in patients with degenerative valve disease. Our initial observations (1981-1990) revealed that most patients with SAM can be successfully treated medically. Here the authors review the last 16 years of their experience with SAM after MVr. ⋯ In the more recent era, SAM occurs one-third less frequently after repair of degenerative mitral valve disease. Use of an incomplete annuloplasty band rather than a complete ring is associated with a lower incidence of SAM. The mainstay treatment of SAM continues to be medical management.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Observational StudyMinimally invasive right thoracotomy approach for mitral valve surgery in patients with previous sternotomy: a single institution experience with 173 patients.
This study presents a review of our experience with minimally invasive mitral valve surgery (MIMVS) in patients with a previous cardiac procedure performed through a sternotomy over a 10-year period. ⋯ Reoperative mitral valve surgery can be safely performed through a right minithoracotomy with good early and late outcomes. The avoidance of extensive surgical dissection, optimal valve exposure, and low blood transfusion are the main advantages of this technique.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Bayesian stopping guidelines for heart valve premarket approval studies.
The Data Monitoring Committee (DMC) for the premarket approval (PMA) study of a new heart valve prosthesis convenes periodically to review the accumulating results of the study, and determines, among other things, whether there is enough concern with safety to stop the study. Their deliberations are largely subjective, based on their combined experience and expertise, but an objective aid to evaluating complication rates, usually called a stopping rule, is desirable. ⋯ Although the DMC ultimately uses combined experience and expertise to make the decision to stop a PMA valve study, we have provided an objective assessment of the probability of the valve ultimately passing the OPC test to aid in making that decision.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Endovascular repair for blunt thoracic aortic injury: 11-year outcomes and postoperative surveillance experience.
Surveillance for patients undergoing thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury (BTAI) varies. Annual chest computed tomographic angiography (CTA) is often recommended but concerns about the risks and costs have emerged. The aim of this study was to examine the optimal follow-up frequency based on 11-year outcomes and surveillance experience. ⋯ Midterm outcomes of TEVAR for patients with stable repair after BTAI are excellent, both with timely (1.0-1.5 years) and delayed (>1.5 years) follow-up intervals after a median surveillance period of 3 years. A larger prospective randomized study could lead to a more relaxed, but equally safe surveillance schedule for these patients, lowering risks and costs.