The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2019
Long-term outcomes of total arch replacement using a 4-branched graft.
Our study evaluated the long-term outcomes of total arch replacement using a 4-branched graft. ⋯ The long-term outcomes for patients undergoing total arch replacement using 4-branched graft are favorable. However, even in the late phase, periodic follow-up is necessary to address subsequent aorta-related events.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
The protective effect of prone lung position on ischemia-reperfusion injury and lung function in an ex vivo porcine lung model.
Prone positioning has been shown to improve oxygenation in patients with lung injury. We hypothesized that prone positioning of lungs during ex vivo lung perfusion (EVLP) can not only improve oxygenation but also diminish ischemia-reperfusion injury (IRI). The aim of our study was to evaluate the potential benefits of prone positioning of lungs during EVLP compared with the standard supine position. ⋯ These data suggest that prone positioning of lungs during EVLP may diminish IRI during EVLP and improve lung function.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
A new paradigm in the management of acute type A aortic dissection: Total aortic repair.
The currently accepted guidelines of open surgical repair for acute type A aortic dissection include the resection of the primary entry tear, replacement of the ascending aorta and "hemi-arch" with an open distal anastomosis, and aortic valve resuspension and some form of obliteration of the aortic root false lumen. The principal aim is protection against aortic rupture, aortic regurgitation, and coronary ischemia and restoration of antegrade preferential true lumen perfusion. Proponents argue that this operation is tailored to be in the armamentarium of most cardiac surgeons and deliver the lowest early operative risk while leaving the infrequent long-term sequelae to be dealt with electively by experienced aortic centers. ⋯ We describe a total aortic repair technique for acute type A aortic dissection consisting of "branch first" total arch repair, followed by thoracoabdominal stenting and balloon rupture of the septum. The total aortic repair technique ensures that the aortic valve, ascending aorta, and arch are surgically securely repaired, and provides complete decompression of the false lumen as well as internal support in the remainder of the aorta. This has provided excellent early results and will hopefully minimize future complications and interventions.
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J. Thorac. Cardiovasc. Surg. · Jan 2019
Noninvasive mapping before surgical ablation for persistent, long-standing atrial fibrillation.
The study objective was to study the electrophysiologic mechanism of atrial fibrillation using a noninvasive, beat-by-beat, 3-dimensional mapping technique in patients with persistent and long-standing persistent atrial fibrillation undergoing concomitant surgical ablation. ⋯ This is the first report on the preoperative use of the ECUVE in surgical candidates for concomitant surgical procedures. The fact that a biatrial mechanism for atrial fibrillation was detected in all patients emphasizes the importance of a Cox-Maze III/IV procedure to treat patients with valvular heart disease and nonparoxysmal atrial fibrillation. Preoperative mapping has the potential to significantly improve our understanding of the pathophysiology in atrial fibrillation and better guide the surgical ablation procedure of choice in a single patient.