The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Aug 2014
Interpapillary muscle distance independently affects severity of functional mitral regurgitation in patients with systolic left ventricular dysfunction.
Surgical papillary muscle (PM) imbrication has been reported to be effective to relieve leaflet tethering in patients with functional mitral regurgitation (FMR). However, the mechanism that contributes to improvement of FMR by shortening the interpapillary muscle distance (IPMD) has not been well investigated. The purpose of the present study was to investigate whether IPMD can affect MR severity independently of PM tethering distance in patients with left ventricular dysfunction (LVD) using multislice computed tomography. ⋯ IPMD, which affects leaflet tethering independently of PM tethering distance, was the major determinant of mitral tenting volume and FMR severity in patients with LVD.
-
J. Thorac. Cardiovasc. Surg. · Aug 2014
Nationwide survey of US integrated 6-year cardiothoracic surgical residents.
Integrated 6-year cardiothoracic surgical residency programs have recently been implemented in the United States. We report the results of the first published nationwide survey assessing the motivations, satisfaction, and ambitions of integrated 6-year residents. ⋯ This survey takes an important snapshot of the nascent integrated 6-year format. Mentorship and intense clinical exposure are critical in attracting applicants. Purported advantages of the format are holding true among integrated 6-year residents, with the majority satisfied with their programs. These early data indicate that this format holds significant promise in attracting and retaining highly qualified trainees to academic cardiothoracic surgery.
-
J. Thorac. Cardiovasc. Surg. · Aug 2014
Laryngopharyngeal dysfunction independent of vocal fold palsy in infants after aortic arch interventions.
Laryngopharyngeal dysfunction contributes significantly to morbidity, length of stay, and increased resource utilization after aortic arch interventions in infants. Previous studies have focused on postoperative evaluation of selected symptomatic patients with vocal fold palsy (VFP). A prospective evaluation of laryngopharyngeal function was undertaken to assess and determine its importance in perioperative management. ⋯ Postoperative laryngopharyngeal dysfunction is common among infants undergoing aortic arch interventions, and is largely independent of vocal fold function. Preoperative evaluation demonstrates significant intrinsic abnormalities in sensory and motor function. Routine, comprehensive, multimodality preoperative and postoperative evaluation is required to identify at-risk children and reduce morbidity and resource utilization.
-
J. Thorac. Cardiovasc. Surg. · Aug 2014
In which patients is transcatheter aortic valve replacement potentially better indicated than surgery for redo aortic valve disease? Long-term results of a 10-year surgical experience.
Redo aortic valve replacement procedures have been reduced by the growing practice of trans-catheter aortic valve-in-valve procedures. We analyzed our long-term results of redo aortic valve replacement procedures during a 10-year period in an effort to define subgroups in which trans-catheter aortic valve-in-valve procedures may be better than surgery. ⋯ Redo aortic valve replacement procedures achieves good results, especially in nonendocarditic or elective cases, and young or New York Heart Association functional class I/II patients. Indeed, endocarditis significantly affects outcome. New York Heart Association functional class IV and nonelective procedures might benefit from trans-catheter aortic valve-in-valve procedures.