The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Comparative StudyEarly surgical intervention versus watchful waiting and outcomes for asymptomatic severe aortic regurgitation.
The management of asymptomatic patients with severe aortic regurgitation remains controversial. Accordingly, the aim of the present study was to assess the long-term outcomes and incidence of cardiac complications among asymptomatic patients with severe aortic regurgitation who underwent operation early, in the absence of any class I or class IIa guideline triggers, or were managed conservatively and eventually underwent operation whenever these triggers appeared. ⋯ Our results show that the outcome of asymptomatic patients with severe aortic regurgitation is not different between an early surgical and a more conservative strategy, provided that the conservatively managed patients are regularly followed up and timely referred to surgery as soon as operative triggers develop. This suggests that surgery should not be recommended in patients with aortic regurgitation who do not meet current guidelines for intervention.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Case ReportsMicrosurgical reconstruction of combined tracheal and total esophageal defects.
Lesions involving both the trachea and the esophagus are often considered inoperable because of the lack of reliable reconstruction. The purpose of this study was to review our experience of combined supercharged jejunal and other flaps for tracheal and esophageal reconstruction. ⋯ Complex and often life-threatening lesions involving both the trachea and the esophagus are not necessarily inoperable. With careful planning, these combined defects can be safely reconstructed with multiple flaps with good functional outcomes and reasonable survival.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
In situ constructive myocardial remodeling of extracellular matrix patch enhanced with controlled growth factor release.
In an effort to expand treatment for advanced heart failure, we sought to develop a tissue-engineered cardiac patch for constructive and functional in situ myocardial regeneration. ⋯ The extracellular matrix patch enhanced with controlled release of fibroblast growth factor facilitated in situ constructive repopulation of the host cells, including cardiomyocyte and functional regeneration, increased regional contractility and tissue perfusion, and positive electrical activity in a porcine preparation.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Comparative StudyLate outcomes after the Cox maze IV procedure for atrial fibrillation.
The Cox maze IV procedure (CMPIV) has been established as the gold standard for surgical ablation; however, late outcomes using current consensus definitions of treatment failure have not been well described. To compare to reported outcomes of catheter-based ablation, we report our institutional outcomes of patients who underwent a left-sided or biatrial CMPIV at 5 years of follow-up. ⋯ The outcomes of the CMPIV remain good at late follow-up. The type of preoperative AF or the addition of a concomitant procedure did not affect late success. The results of the CMPIV remain superior to those reported for catheter ablation and other forms of surgical AF ablation, especially for patients with persistent or longstanding AF.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Comparative StudyAssessment of mitral annuloplasty ring by cardiac computed tomography: Correlation with echocardiographic parameters and comparison between two different ring types.
This study investigated computed tomographic (CT) appearance after mitral ring annuloplasty, especially comparing CT findings between patients with normal pressure gradient (PG) and patients with functional mitral stenosis (MS) and between 2 commonly used types of annuloplasty ring. ⋯ Significant pannus around the annuloplasty ring on CT may cause functional MS after mitral ring annuloplasty. This may occur more frequently with the Duran ring.