The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2019
An in vitro analysis of the PediMag and CentriMag for right-sided failing Fontan support.
Right-sided mechanical circulatory support for failing Fontan physiology has been largely unsuccessful due to inherent hemodynamic differences between these patients and the target populations for most assist devices. This study uses advanced benchtop modeling of Fontan physiology to examine the use of PediMag and CentriMag to improve failing Fontan hemodynamics. ⋯ PediMag and CentriMag right-sided support led to a decrease in inferior vena cava pressure and augmentation of cardiac output. In the case of CentriMag, this is accomplished without an increase in superior vena cava pressure or the need for restrictive banding. This work provides further data to help with the optimal design of a Fontan assist device to ameliorate the growing need.
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J. Thorac. Cardiovasc. Surg. · Nov 2019
A functional assessment of the circle of Willis before aortic arch surgery using transcranial Doppler.
Antegrade selective cerebral perfusion (ASCP) with systemic moderate hypothermia is routinely used as brain protection during aortic arch surgery. Whether ASCP should be delivered unilaterally (u-ASCP) or bilaterally (bi-ASCP) remains controversial. ⋯ The risk of ischemic brain damage due to malperfusion is estimated to be substantially higher during right u-ASCP than during bi-ASCP. Bi-ASCP is therefore highly preferable over u-ASCP if the function of the CoW is unknown. We propose a tailored approach using this full functional assessment preoperatively by applying u-ASCP via the right subclavian artery when considered safely possible, and bi-ASCP when considered a necessity to prevent cerebral malperfusion, and thus thereby try to reduce the embolic stroke risk of ostial instrumentation in bi-ASCP.
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J. Thorac. Cardiovasc. Surg. · Nov 2019
Is it justified to apply a modified Cabrol fistula in surgical repair of acute type A aortic dissection?
Open repair of acute type A aortic dissection frequently results in oozing from the suture lines. A modified fistula technique was developed to rapidly control oozing and allow closing the chest immediately and safely. The efficiency of this modified fistula technique in surgical repair of acute type A aortic dissection was evaluated. ⋯ During surgical repair of acute type A aortic dissection, a modified Cabral fistula technique can rapidly control oozing and effectively improve the short-term outcomes.
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J. Thorac. Cardiovasc. Surg. · Nov 2019
Hybrid and frozen elephant trunk for total arch replacement in DeBakey type I dissection.
The study objective was to determine whether hybrid aortic repair yields superior outcomes compared with the conventional surgical approach for DeBakey type I aortic dissection. ⋯ Hybrid aortic arch repair is a viable alternative treatment for patients with DeBakey type I aortic dissection, which improves outcomes and promotes remodeling of the dissected thoracic aorta.
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J. Thorac. Cardiovasc. Surg. · Nov 2019
Outcomes of surgery for infective endocarditis in children: A 30-year experience.
Infective endocarditis (IE) is rare in children. Limited data have been reported on long-term outcomes of children who undergo surgery for IE. ⋯ Children undergoing surgery for IE had good long-term survival and recurrence of IE was uncommon. Surgery during the active phase of endocarditis did not increase risk of mortality or reoperation. In patients with left-sided IE, vegetation size adjusted for patient body surface area was identified as a risk factor for death, and a useful indicator of prognosis.