The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Comparative StudyReoperative surgery on the thoracoabdominal aorta.
Since the advent of endovascular repair for aortic aneurysms, many centers have justified the use of endovascular approaches in patients with previous open distal aortic repair by deeming these patients "high risk" because of their previous operation. We sought to determine whether patients who undergo reoperative repair for thoracoabdominal aortic aneurysm (TAAA) have worse outcomes than patients who undergo non-reoperative repair. ⋯ We were unable to detect noteworthy differences in early outcomes between reoperative and non-reoperative TAAA repair. However, mid-term results indicate worse survival for patients who undergo reoperative surgery.
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Multicenter StudyA multi-institutional cohort study confirming the risks of Clostridium difficile infection associated with prolonged antibiotic prophylaxis.
The incidence and severity of Clostridium difficile infection (CDI) have increased rapidly over the past 2 decades, particularly in elderly patients with multiple comorbidities. This study sought to characterize the incidence and risks of these infections in cardiac surgery patients. ⋯ In this large multicenter prospective study of major infections following cardiac surgery, CDI was encountered in nearly 1% of patients, was frequently diagnosed postdischarge, and was associated with extended length of stay and substantially increased mortality. Patients with comorbidities, longer surgery time, extended antibiotic exposure, and/or hyperglycemic episodes were at increased risk for CDI.
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Comparative StudyRight ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants.
To assess the outcomes following primary tetralogy of Fallot (TOF) repair in neonates and young infants with pulmonary stenosis (PS) and pulmonary atresia and compare differences in reintervention on the right ventricular outflow tract (RVOT) among those undergoing valve sparing repair (VSR), transannular RVOT patch (TAP), and right ventricle-to-pulmonary artery (RV-PA) conduit surgeries. ⋯ Neonatal TOF repair can be performed with low mortality but frequent RVOT reinterventions. Surgical reintervention is earlier and the rate is higher among patients with TOF/PA undergoing RV-PA conduit repair compared with those undergoing TAP. Although there were no overall differences in RVOT reintervention rate between patients with TOF/PS undergoing VSR and those undergoing TAP, a lower birth weight in the patients undergoing VSR is associated with a higher surgical reintervention rate.
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J. Thorac. Cardiovasc. Surg. · Feb 2018
Randomized Controlled TrialA prospective randomized trial of the cut-and-sew Maze procedure in patients undergoing surgery for rheumatic mitral valve disease.
To evaluate the safety and efficacy of the addition of the cut-and-sew Maze III procedure (CSM) for mitral valve replacement (MVR) in patients with atrial fibrillation (AF) associated with rheumatic mitral valve disease (RMVD). ⋯ Addition of the CSM to an MVR procedure can decrease the risk of stroke or death and high sinus rhythm at 1 year without increasing the operative risk. CSM is a safe and effective approach to treating AF associated with RMVD.