The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative StudyComparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm.
Valve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients. ⋯ VSRR is an effective alternative to the BVC for aortic root aneurysm.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Increased common atrioventricular valve tenting is a risk factor for progression to severe regurgitation in patients with a single ventricle with unbalanced atrioventricular septal defect.
Significant atrioventricular valve regurgitation (AVVR) increases mortality in patients with unbalanced atrioventricular septal defects (uAVSDs) and a single ventricle. We tested the hypothesis that abnormal leaflet tethering is associated with progressive AVVR in patients with a single ventricle with uAVSD. ⋯ Early leaflet tethering is predictive of subsequent AVVR in patients with a single ventricle with uAVSD. Patients with competent AVV had progressive reduction in the degree of leaflet tethering, whereas patients with AVVR did not. This may represent an important adaptive process to maintain valve competency in uAVSD.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative Study Observational StudyGuidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups.
Increasing evidence from observational cohort studies supports a survival advantage from bilateral internal thoracic artery (BITA) relative to single internal thoracic artery (SITA) grafts in patients undergoing coronary artery bypass grafting. Whether the survival benefit from BITA is related to patient age and any potential age cutoff for the loss of survival benefit from BITA remain to be determined. ⋯ This study provides robust scientific evidence for the loss of survival benefit from BITA for patients older than 69 years.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Long-term results of aggressive hemiarch replacement in 534 patients with type A aortic dissection.
To present the outcomes of routinely performed hemiarch replacement in patients with acute type A aortic dissection. ⋯ Aggressive hemiarch replacement in acute type A dissection can be performed with low mortality and low aortic arch reoperation rate. Resection of all dissected aortic wall tissue decreases, but does not eliminate, the risk of later adverse aortic events.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Clostridium difficile infection after cardiac surgery: prevalence, morbidity, mortality, and resource utilization.
Despite increasing efforts to prevent infection, the prevalence of hospital-associated Clostridium difficile infections (CDI) is increasing. Heightened awareness prompted this study of the prevalence and morbidity associated with CDI after cardiac surgery. ⋯ Although rare, the prevalence of CDI is increasing, contributing importantly to morbidity and mortality after cardiac surgery. If toxic colitis develops, mortality is high, but colectomy may be lifesaving.