The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Heart block following stage 1 palliation of hypoplastic left heart syndrome.
Publicly available data from the Pediatric Heart Network's Single Ventricle Reconstruction Trial was analyzed to determine the prevalence, timing, risk factors for, and impact of second- and third-degree heart block (HB) on outcomes in patients who underwent stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS). ⋯ HB after S1P is rare but heralds a poor outcome. Careful monitoring of these patients is recommended given their significantly increased risks of death and heart transplantation.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
EditorialCardiothoracic surgical critical care certification: A future of distinction.
Cardiothoracic surgical critical care has emerged as a unique area of practice within cardiothoracic surgery. Leaders of multidisciplinary, high-performing teams are uniquely educated, trained, and skilled surgeons. Certification in this specialty by the American Board of Thoracic Surgery is a recognition of their distinction. A foundational framework is proposed toward this goal.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Aortic valve replacement with a 17-mm mechanical prosthesis in octogenarian or older patients.
Few studies have reported on aortic valve replacement (AVR) in patients aged >80 years who have small aortic annuli. Various surgical techniques have been proposed for treating such patients. We investigated AVR using small-diameter mechanical valves, in patients aged >80 years, to determine its effectiveness. ⋯ In patients aged >80 years who have small aortic annuli, AVR using a 17-mm prosthesis showed satisfactory clinical and hemodynamic results and provided a satisfactory remote prognosis.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Transplantation of "high-risk" donor hearts: Implications for infection.
Heart transplantation is the gold-standard treatment for end-stage heart failure. Short- and long-term outcomes have been excellent, but the shortage of organs persists. The number of potential recipients who die while awaiting orthotopic heart transplantation increases yearly. In 2004, the label "high-risk donor" (HRD) was applied, by the United Network for Organ Sharing (UNOS), to any organ donor who met the Centers for Disease Control (CDC) criteria for behavior that put them at high risk of infection. Despite organ shortages, grafts from HRD CDCs are often declined, because of concerns regarding infection. We undertook this study to analyze our extensive experience with orthotopic heart transplantation of grafts from HRD CDCs, and to determine the short- and long-term outcomes associated with recipients of hearts from HRD CDCs, particularly transmission of infection. ⋯ We present the only single-center series on recipients of heart transplants from HRD CDCs. This potential source of suitable donor organs is shown to lead to excellent survival, without an increased incidence of perioperative or postoperative complications. Furthermore, the risk of transmission of infection from donors in this subgroup seems to be minimal.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Incidence and characteristics of heart block after heart surgery in pediatric patients: A multicenter study.
Advanced second- or third-degree heart block has been reported with variable incidence after surgery for congenital heart disease in children. We report the incidence of heart block requiring a pacemaker and describe the risk factors for this complication in a large multicenter study. ⋯ The incidence of postoperative heart block requiring permanent pacemaker placement immediately after congenital heart surgery is low (1%). However, these patients have higher mortality even after adjusting for heart surgery complexity.