The Journal of thoracic and cardiovascular surgery
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The study objective was to examine the long-term results of the Ross procedure in a cohort of patients followed prospectively for more than 2 decades. ⋯ The long-term results of the Ross procedure are excellent regardless of the implantation technique, but there is a progressive deterioration of function of both semilunar valves.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
Risk of stroke early after implantation of a left ventricular assist device.
Stroke is one of the major adverse events after left ventricular assist device implantation. Risk of stroke is the highest immediately after left ventricular assist device implantation and then increases again in chronic periods. There is no study that has analyzed risk factors for stroke in acute phase. We investigated the risk factors for stroke in the acute phase after left ventricular assist device implantation in the present study. ⋯ Our study demonstrated that patients with perioperative lower cardiac output and higher lactate dehydrogenase level developed stroke in the acute phase after left ventricular assist device implantation. These results suggested that maintenance of sufficient left ventricular assist device flow is important in prevention of stroke, which may be related to subclinical pump thrombosis.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
Proximal aortic surgery in the elderly population: Is advanced age a contraindication for surgery?
The study objective was to describe the clinical outcomes of elderly patients undergoing ascending aortic surgery. ⋯ After adjusting for these comorbidities, the cause of aortic disease, and the type of procedure, age was not an independent predictor of operative mortality, but was strongly associated with reduced late survival. Thus, advanced age alone should not be an absolute contraindication for ascending aortic surgery.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
Observational StudyEarly intraoperative iron-binding proteins are associated with acute kidney injury after cardiac surgery.
Iron regulation is an important modifier of renal ischemia-reperfusion injury, but the role of iron-binding proteins during cardiopulmonary bypass remains unclear. The goal was to characterize iron-binding proteins throughout ischemia-reperfusion injury to determine their association with acute kidney injury development. ⋯ Our findings suggest that lower levels of intraoperative iron-binding proteins may reflect an impaired capacity to rapidly handle catalytic iron released during cardiopulmonary bypass, leading to kidney injury. These data highlight the importance of iron homeostasis in human ischemia-reperfusion injury and suggest it is a potentially modifiable risk during cardiac surgery. Intraoperative detection of incipient acute kidney injury may be feasible and could be used as an enrichment strategy for clinical trials.