The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2021
Utility of neuromonitoring in hypothermic circulatory arrest cases for early detection of stroke: Listening through the noise.
Stroke remains a potentially devastating complication of aortic arch intervention. The value of neurophysiologic intraoperative monitoring (NIOM) in the early identification of stroke is unclear. We evaluated the utility of NIOM for early stroke detection in aortic arch surgery. ⋯ Despite a low positive predictive value requiring a high level of discrimination when interpreting abnormal findings, NIOM has high sensitivity and specificity for the early stroke detection. Furthermore, its high negative predictive valve is reassuring for low risk of stroke in the absence of alerts.
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J. Thorac. Cardiovasc. Surg. · Oct 2021
EditorialAdministrative and clinical databases: General thoracic surgery perspective on approaches and pitfalls.
Databases are created to serve 1 of 2 fundamental functions: (1) research and (2) benchmarking/quality. Their construction and nature affects the extent to which they can accomplish these functions.
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J. Thorac. Cardiovasc. Surg. · Oct 2021
EditorialSurgical ablation of atrial fibrillation in patients with heart failure.
Both congestive heart failure (HF) and atrial fibrillation (AF) are important and increasingly common forms of cardiovascular disease in the 21st century. Heart failure is often complicated by AF, and AF can exacerbate and, in some cases, cause HF, also known as tachycardia-induced cardiomyopathy (TIC). ⋯ However, many surgeons are reluctant to perform stand-alone or concomitant CMP IV in this high-risk cohort of patients. In this review, the over three decades of experience with surgical ablation will be reviewed along with the essential information that surgeons need to be aware of as they participate in the team-based care of patients with AF and HF.
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J. Thorac. Cardiovasc. Surg. · Oct 2021
Anterior versus posterior leaflet mitral valve repair: A propensity-matched analysis.
Mitral valve repair is superior to replacement for degenerative disease, but long-term outcomes of anterior versus posterior leaflet repair remain poorly defined. We propensity matched anterior and posterior repairs to compare long-term outcomes. ⋯ No long-term survival or reoperation difference was found between posterior and anterior repair. On the basis of these findings, surgeons at centers of excellence should aim for repair of both anterior and posterior leaflet pathology with the same decision-making threshold over valve replacement for degenerative mitral disease.
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We aimed to assess the long-term outcomes of children in whom the aortic valve could be repaired without the use of patch material. We hypothesized that if the aortic valve is of sufficiently good quality to perform repair without patches, a durable repair could be achieved. ⋯ In approximately one-third of children undergoing aortic valve repair, the repair could be achieved without patches. In these children, aortic valve repair was achieved without operative mortality. Infants and older children have low reoperation rates, whereas reoperation rates in neonates are higher. Initial repair allows valve replacement to be delayed to later in childhood, when a more durable result may be achieved.