The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2014
Randomized Controlled Trial Comparative StudyWeight-based versus set dosing of vancomycin for coronary artery bypass grafting or aortic valve surgery.
This study was undertaken to identify a preferred dosing strategy for patients undergoing coronary artery bypass grafting or valve replacement procedures with cardiopulmonary bypass. ⋯ Weight-based vancomycin dosing before coronary artery bypass grafting or valve replacement results in vancomycin concentrations greater than 15 μg/mL consistently more than does standard 1-g dosing.
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J. Thorac. Cardiovasc. Surg. · Jun 2014
Valve-sparing aortic root replacement and remodeling with complex aortic valve reconstruction in children and young adults with moderate or severe aortic regurgitation.
The durability of valve-sparing aortic root procedures with aortic regurgitation due to leaflet disease is questioned. Here, we review our experience in combined aortic root and valve reconstruction in children and young adults. ⋯ Valve-sparing root and valve reconstruction can be done with low operative risk and allows valve preservation in most patients. These data should question the assumption that reimplantation is superior when associated with complex valve reconstruction.
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J. Thorac. Cardiovasc. Surg. · Jun 2014
Valve replacement surgery for older individuals with preoperative atrial fibrillation: the effect of prosthetic valve choice and surgical ablation.
Prosthetic valve type selection combined with surgical ablation during left-sided heart valve replacement in older individuals with atrial fibrillation remains controversial. ⋯ Long-term survival after valve replacement in older individuals with atrial fibrillation was affected by several preoperative characteristics and the performance of surgical ablation but not by the choice of prosthesis. These findings suggest that surgical atrial fibrillation ablation should always be considered for these patients, regardless of the prosthesis type used.
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J. Thorac. Cardiovasc. Surg. · Jun 2014
Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy: the preferred approach for contemporary surgical candidates?
Patients with hypertrophic obstructive cardiomyopathy due to diffuse hypertrophy extending to or below the papillary muscles are poor candidates for alcohol septal ablation and suboptimal candidates for transaortic septal myectomy. In addition, the outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus. ⋯ We believe that this technique is preferable for patients with hypertrophic obstructive cardiomyopathy and diffuse hypertrophy extending to the midportion of the left ventricle or beyond. It results in disappearance of outflow tract gradients and allows correction of the mitral valve abnormality.
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J. Thorac. Cardiovasc. Surg. · Jun 2014
Editorial Historical ArticleMechanical circulatory assist device development at the Texas Heart Institute: a personal perspective.
In December 2013, we performed our 1000th ventricular assist device implantation at the Texas Heart Institute. In my professional career, I have been fortunate to see the development of numerous mechanical circulatory support devices for the treatment of patients with advanced heart failure. In fact, most of the cardiac pumps in wide use today were developed in the Texas Heart Institute research laboratories in cooperation with the National Heart, Lung and Blood Institute or device innovators and manufacturers and implanted clinically at our partner St. ⋯ Also, many of the advances are directly attributable to my ongoing clinical experience. What I learned daily in my surgical practice allowed me to bring insights to the development of this technology that a laboratory researcher alone might not have had. Young academic surgeons interested in this field might be well served to be active not only in laboratory research but also in clinical practice.