The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jan 2018
Effect of motor subtypes of delirium in the intensive care unit on fast-track failure after cardiac surgery.
The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. ⋯ Patients with pure hypoactive delirium had a similar risk of developing fast-track failure as other motor subtypes. Differentiation of motor subtypes is unlikely to be clinically important for prognostication of fast-track failure. However, because delirium is associated with poor outcomes, potential treatment strategies should address all subtypes equally.
-
J. Thorac. Cardiovasc. Surg. · Jan 2018
The dynamic cardiac biosimulator: A method for training physicians in beating-heart mitral valve repair procedures.
Previously, cardiac surgeons and cardiologists learned to operate new clinical devices for the first time in the operating room or catheterization laboratory. We describe a biosimulator that recapitulates normal heart valve physiology with associated real-time hemodynamic performance. ⋯ This beating heart biosimulator reproduces prolapsing mitral leaflet pathology. It may be the ideal platform for surgeon and cardiologist training on many transcatheter and beating heart procedures.
-
J. Thorac. Cardiovasc. Surg. · Jan 2018
The association between cardiac physiology, acquired brain injury, and postnatal brain growth in critical congenital heart disease.
To assess the trajectory of perioperative brain growth in relationship to cardiac diagnosis and acquired brain injuries. ⋯ Neonates with HLHS have a slower rate of global and regional brain growth compared with d-TGA, likely related to inherent physiologic differences postoperatively. These findings demonstrate the complex interplay between cardiac lesion, brain injury, and brain growth.
-
J. Thorac. Cardiovasc. Surg. · Jan 2018
Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery.
Atrial fibrillation (AF) is associated with an increased mortality risk. The Cox-maze IV procedure (CM4) performed concomitantly with other cardiac procedures has been shown to be effective for restoring sinus rhythm. However, few data have been published on the late survival of patients undergoing a concomitant CM4. ⋯ For selected patients with a history of AF undergoing cardiac surgery, concomitant CM4 did not add significantly to postoperative morbidity or mortality and was associated with improved late survival compared with patients with untreated AF and a similar survival to patients without a history of AF.
-
J. Thorac. Cardiovasc. Surg. · Jan 2018
Bacterial adherence to graft tissues in static and flow conditions.
Various conduits and stent-mounted valves are used as pulmonary valve graft tissues for right ventricular outflow tract reconstruction with good hemodynamic results. Valve replacement carries an increased risk of infective endocarditis (IE). Recent observations have increased awareness of the risk of IE after transcatheter implantation of a stent-mounted bovine jugular vein valve. This study focused on the susceptibility of graft tissue surfaces to bacterial adherence as a potential risk factor for subsequent IE. ⋯ Our data provide evidence that the surface composition of BJV and CH tissues themselves, bacterial surface proteins, and shear forces per se are not the prime determinants of bacterial adherence.