The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative Study Observational StudySurgery of postinfarction ventricular septal rupture: the effect of David infarct exclusion versus Daggett direct septal closure on early and late outcomes.
David infarct exclusion and Daggett direct septal closure are alternative techniques to repair postinfarction ventricular septal rupture. The aim of the present study was to compare the 2 methods with regard to postoperative morbidity, 30-day mortality, and long-term survival. ⋯ David infarct exclusion was superior to Daggett direct septal closure for early and late survival after surgery for postinfarction ventricular septal rupture. Total coronary revascularization improved survival more in the David than in the Daggett group.
-
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.
-
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.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
Embolic capture with updated intra-aortic filter during coronary artery bypass grafting and transaortic transcatheter aortic valve implantation: first-in-human experience.
We report our first-in-human clinical experience in the use of the new version of the EMBOL-X intra-aortic filter (Edwards Lifesciences Corporation, Irvine, Calif) to capture embolic material during transaortic transcatheter aortic valve implantation and cardiac surgery. ⋯ This first-in-human clinical experience has demonstrated the safety and feasibility of using the new version of the EMBOL-X intra-aortic filter during either cardiac surgery or transaortic transcatheter aortic valve implantation. We believe that the combination of the transaortic approach without aortic arch manipulation and the use of the EMBOL-X filter with a high capture rate is a promising strategy to reduce the incidence of embolic complications during transcatheter aortic valve implantation.
-
J. Thorac. Cardiovasc. Surg. · Dec 2014
A simple surgical technique for closure of apical muscular ventricular septal defect.
Ventricular septal defect (VSD) is among the most common congenital heart diseases encountered in pediatric cardiac patients. Apical muscular VSD constitutes nearly 2% of defects, which may or may not be associated with other congenital heart defects. The purpose of our study is to present our innovative and simple surgical technique using custom-made low-profile polytetrafluoroethylene (PTFE) single disc device for closing multiple apical muscular and isolated apical muscular VSD. ⋯ The technique described by us has the advantage of apical VSD closure through the left ventricle without left ventriculotomy. Our technique is simple and cost-effective.