The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 2016
Effect of aortic pericardial valve choice on outcomes and left ventricular mass regression in patients with left ventricular hypertrophy.
We sought to assess the effect of 2 contemporary pericardial valves on left ventricular mass regression and clinical outcomes after aortic valve replacement (AVR) in patients with aortic stenosis (AS). ⋯ Since February 2011, 258 patients with AS and left ventricular hypertrophy underwent AVR with the Trifecta (TR) (St Jude Medical, St Paul, Minn) or Perimount Magna Ease (ME) (Edwards LifeSciences, Irvine, Calif) bioprosthesis. There were longer bypass and crossclamp times and the indexed left ventricular outflow tract was smaller in the TR group. For the TR and ME, respectively, peak (14.4 ± 5.1 mm Hg vs 20.9 ± 7.2 mm Hg; P < .001) and mean (7.3 ± 2.7 mm Hg vs 10.9 ± 4.3 mm Hg; P < .001) gradients were significantly smaller postoperatively in the TR group. There was greater total mass regression (44.3 g/m2; 95% confidence interval [CI], 36.3-52.3 vs 29.5; 95% CI, 20.4-38.5 g/m2; P = .020) and mass regression over time in the TR group compared with the ME group (P = .016). Freedom from readmission, congestive heart failure, and the composite outcome of all-cause mortality, readmission, and congestive heart failure at 2.5 years was significantly improved in the TR group (composite outcome in TR and ME groups, respectively, 90.2; 95% CI, 81.9-94.9 and 78.2; 95% CI, 67.1-86.0; P = .013) CONCLUSIONS: TR use was associated with significantly increased left ventricular mass regression and improved intermediate-term clinical outcome in patients with left ventricular hypertrophy undergoing AVR for AS, compared with use of the ME.
-
J. Thorac. Cardiovasc. Surg. · Nov 2016
Balancing pulmonary blood flow: Theory, in vitro measurements, and clinical correlation of systemic-to-pulmonary shunt banding.
Size mismatch between body and a systemic-to-pulmonary shunt can result in excessive pulmonary blood flow, compromising systemic oxygen delivery. Previously reported techniques to mechanically restrict shunt flow lack precision and reproducibility. We developed a formula for shunt banding and assessed its efficacy and reproducibility by in vitro and clinical measurements. ⋯ Our formulas and surgical strategy offer a new approach to controlling excessive pulmonary blood flow in shunt-dependent circulations in an effective and predictable way. The best reproducibility was achieved in small, thin-walled shunts. This strategy was most effective in patients with pulmonary overcirculation without hemodynamic decompensation.
-
J. Thorac. Cardiovasc. Surg. · Nov 2016
Vasoactive-ventilation-renal score reliably predicts hospital length of stay after surgery for congenital heart disease.
We aimed to further validate the vasoactive-ventilation-renal score as a predictor of outcome in patients recovering from surgery for congenital heart disease. We also sought to determine the optimal time point within the early recovery period at which the vasoactive-ventilation-renal score should be measured. ⋯ In a heterogeneous population of patients undergoing surgery for congenital heart disease, the novel vasoactive-ventilation-renal score calculated in the early postoperative recovery period can be a strong predictor of prolonged hospital length of stay.
-
J. Thorac. Cardiovasc. Surg. · Nov 2016
The cervicosternolaparotomy approach for the treatment of graft dysfunction after retrosternal esophageal reconstruction for caustic injuries.
The study purpose was to report the indications, technical aspects, and outcomes of cervicosternolaparotomy during revision surgery after esophageal reconstruction for caustic injuries. ⋯ Cervicosternolaparotomy during revision surgery for graft dysfunction is reliable, is associated with low morbidity and mortality, and has good results.