The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2020
MicroRNAs as potential biomarkers in congenital heart surgery.
Pediatric congenital heart surgery (CHS) involves intracardiac, valvular, and vascular repairs. Accurate tools to aid short-term outcome prediction in pediatric CHS are lacking. Clinical scores, such as the vasoactive-inotrope score and ventilation index, are used to define outcome in clinical studies. MicroRNA-1-3p (miR-1) is expressed by both cardiomyocytes and vascular cells and is regulated by hypoxia. In adult patients, miR-1 increases in the circulation after open-heart cardiac surgery, suggesting its potential as a clinical biomarker. Thus, we investigated whether perioperative circulating miR-1 measurements can help predict post-CHS short-term outcomes in pediatric patients. ⋯ Our study suggests miR-1 as a novel potential circulating biomarker to predict early postoperative outcome and inform clinical management in pediatric heart surgery.
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J. Thorac. Cardiovasc. Surg. · Apr 2020
Editorial CommentBacterial infiltration and bioprosthetic valve failure: Emerging diagnostics for emerging therapies.
Despite the increasing use of bioprosthetic heart valves (BHV), the mechanisms underlying BHV failure remain elusive. It has been suggested that bacteria in explanted native valves from patients without clinical or laboratory evidence of infective endocarditis may contribute to structural valve degeneration (SVD). In this editorial we discuss the potential roles of infection and thrombosis in BHV SVD.
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J. Thorac. Cardiovasc. Surg. · Apr 2020
Left ventricular assist device implantation may be feasible in appropriately selected patients with severe renal insufficiency.
Severe renal insufficiency is considered a relative contraindication to left ventricular assist device (LVAD) implantation. After establishing an algorithmic approach to these patients, we hypothesized that LVAD implantation with severe renal insufficiency could be performed without increasing morbidity or mortality. ⋯ LVAD implantation in carefully selected patients with severe renal insufficiency can be performed without increasing midterm morbidity or mortality. This strategy may serve as a successful option to bridge patients to transplantation or destination therapy.
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J. Thorac. Cardiovasc. Surg. · Apr 2020
Comparative StudyOff-pump versus on-pump coronary artery bypass grafting in moderate renal failure.
Off-pump coronary artery bypass (OPCAB) may benefit select high-risk patients. We sought to analyze the long-term outcomes of OPCAB versus on-pump coronary artery bypass (ONCAB) in patients with moderate renal failure. ⋯ OPCAB is associated with improved in-hospital renal outcomes, but is not associated with changes in short- or long-term mortality, or with the long-term cumulative incidence of end-stage renal failure requiring permanent dialysis in patients with moderate renal failure.
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J. Thorac. Cardiovasc. Surg. · Apr 2020
Right ventricular function is reduced during cardiac surgery independent of procedural characteristics, reoperative status, or pericardiotomy.
Long-axis right ventricular (RV) function, which provides nearly 80% of RV ejection, acutely decreases during cardiac surgery. RV dysfunction increases risk for perioperative morbidity and mortality. Our objective was to characterize the change in perioperative RV long-axis and global function by determining the influence of procedure type, surgical approach, and reoperative status and examining its temporal relationship to pericardiotomy versus cardiopulmonary bypass (CPB) and cardioplegia. ⋯ Acute intraoperative reduction in RV function occurs following CPB, independent of procedural characteristics and pericardiotomy. Etiology and clinical implications of reduced perioperative RV function remain to be determined.