The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2015
Observational StudySurgical treatment of paravalvular leak: Long-term results in a single-center experience (up to 14 years).
The aim of this study is to report the long-term outcomes (median follow-up time, 7 years; range, 1 month to 14 years) of patients who underwent surgery for paravalvular leak in our single-center experience. ⋯ The operative mortality of surgical treatment of paravalvular leak is still high. Long-term outcomes remain suboptimal in these challenging patients, especially in the presence of multiple previous cardiac operations and associated co-pathologies. These results support the importance of alternative therapeutic options.
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J. Thorac. Cardiovasc. Surg. · May 2015
Observational StudyThe early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study.
Extracorporeal membrane oxygenation (ECMO) is used to support postcardiotomy cardiogenic shock patients. Elevated serum lactate levels might reflect hypoxia in the tissues, which is associated with mortality in critically ill patients. This study examined the association between the early dynamic behavior of lactate and mortality after ECMO support. ⋯ In addition to age and gender (female), early lactate behaviors, particularly lactate clearance, after ECMO support are highly associated with in-hospital mortality in postcardiotomy patients. Additionally, early lactate behavior is also predictive of successful weaning from ECMO.
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J. Thorac. Cardiovasc. Surg. · May 2015
Preserving the pulmonary valve during early repair of tetralogy of Fallot: Anatomic substrates and surgical strategies.
To describe the anatomy of the PV in tetralogy of Fallot (TOF) and to define the influence of PV anatomy on the development of surgical techniques for PV preservation during early repair. ⋯ The majority of patients with TOF (>90%) have a bicuspid or tricuspid PV, which is the most favorable surgical anatomy for preserving the PV, independent of the degree of leaflet dysplasia. The recent introduction of more-complex PV plasty techniques, such as delamination plasty, allowed us to further extend the applicability of PV-preservation techniques.
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J. Thorac. Cardiovasc. Surg. · May 2015
Anatomical risk factors, surgical treatment, and clinical outcomes of left-sided pulmonary vein obstruction in single-ventricle patients.
Patients with single-ventricle physiology frequently develop left-sided pulmonary vein obstruction (PVO), in which the pulmonary veins traverse the descending thoracic aorta. We hypothesized that a combination of cardiomegaly and an anteriorly positioned descending aorta is associated with PVO. ⋯ The combination of relative cardiomegaly within the context of the thoracic cavity at the level of the pulmonary veins and antero-lateral displacement of the aorta is associated with left-sided PVO and subsequent failure to achieve Fontan completion. Further characterization of these unique geometric relationships may help inform both surveillance strategies and decision making in the timing of interventions, and guide the intraoperative objectives at the time of PVO repair.
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J. Thorac. Cardiovasc. Surg. · May 2015
Comparative Study Observational StudyNational trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements.
Substantial controversy surrounds the choice between a mechanical versus bioprosthetic prosthesis for aortic valve replacement (AVR), based on age. This study aims to investigate national trends and in-hospital outcomes of the 2 prosthesis choices. ⋯ Use of bioprosthetic valves in AVR increased dramatically from 1998 to 2011, particularly in patients age 55 to 64 years. Prosthesis selection varied significantly by facility, with low-volume facilities favoring mechanical valves. Aortic valve replacement with a bioprosthetic valve, compared with a mechanical valve, was associated with lower in-hospital mortality.