The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · May 2016
Comparative StudyResistance to infection of long-term cryopreserved human aortic valve allografts.
To analyze the in vitro antimicrobial activity of 3 antibiotic regimens (group A, gentamicin-piperacillin-vancomycin-metronidazole-amphotericin B; group B, gentamicin-piperacillin-flucloxacillin-metronidazole-amphotericin B; and group C, meropenem-vancomycin-tobramycin-colistin-amphotericin B) used in the processing of cryopreserved human ascending aortic tissue and aortic valves against Staphylococcus epidermidis and Staphylococcus aureus. The results were additionally compared with the infection resistance of cryopreserved ascending aortic tissue against Escherichia coli and Pseudomonas aeruginosa. ⋯ CHAs possess antibacterial activity despite long-term storage over 5 years. Antibiotic combinations applied during CHA processing have a significant influence on their infection resistance. Ascending aortic tissue shows a significantly enhanced bacterial resistance against staphylococcal bacteria compared with aortic valves.
-
J. Thorac. Cardiovasc. Surg. · May 2016
Early results of extra-aortic annuloplasty ring implantation on aortic annular dimensions.
Dilatation of the aortic annulus is a cause of recurrent aortic regurgitation following the Ross or Yacoub procedures. Use of an extra-aortic annuloplasty ring is a potentially useful adjunct procedure. The aim of this study was to analyze the early effectiveness and mid-term stability of this surgical approach. ⋯ Use of an extra-aortic annuloplasty ring is effective at reducing annular diameters. This remains stable at mid-term follow-up, with preservation of aortic annular dynamics. Longer-term studies are required to determine the continued stability and impact on long-term clinical outcomes.
-
J. Thorac. Cardiovasc. Surg. · May 2016
Neurodevelopmental outcome in hypoplastic left heart syndrome: Impact of perioperative cerebral tissue oxygenation of the Norwood procedure.
Patients with hypoplastic left heart syndrome are at risk for neurodevelopmental impairment. Hypoxic-ischemic brain injury during neonatal treatment might be a relevant cause. We evaluated the association between cerebral oxygenation in the perioperative course of the Norwood procedure and neurodevelopmental outcome. ⋯ Neurodevelopmental outcome was in the lower-normal range. Along with innate patient factors, preoperative cerebral tissue oxygenation is likely an important determinant of cognitive development.
-
J. Thorac. Cardiovasc. Surg. · May 2016
Are homografts superior to conventional prosthetic valves in the setting of infective endocarditis involving the aortic valve?
Surgical dogma suggests that homografts should be used preferentially, compared with conventional xenograft or mechanical prostheses, in the setting of infective endocarditis (IE), because they have greater resistance to infection. However, comparative data that support this notion are limited. ⋯ No significant benefit to use of homografts was demonstrable with regard to resistance to reinfection in the setting of IE. The choice among prosthetic options should be based on technical and patient-specific factors. Lack of availability of homografts should not impede appropriate surgical intervention.
-
J. Thorac. Cardiovasc. Surg. · May 2016
Adventitial inversion technique for type A aortic dissection distal anastomosis.
Anastomosis in dissected aorta management remains challenging. The patent false lumen of remnant aorta influences the growth of the residual aorta after hemiarch replacement. We evaluated the beneficial effect of adventitial inversion technique for distal anastomotic reinforcement of hemiarch replacement in acute type A aortic dissection. ⋯ The adventitial inversion technique may facilitate thrombotic closure of the distal false lumen in acute type A aortic dissection management by hemiarch replacement.