The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2021
A novel unidirectional-valved shunt approach for end-stage pulmonary arterial hypertension: Early experience in adolescents and adults.
Despite advances in treatment of idiopathic pulmonary arterial hypertension (IPAH), there remains no medical cure, and patients can experience disease progression leading to right heart failure, progressive exercise intolerance, and death. The reversed Potts shunt (left pulmonary artery to descending aorta) was reintroduced for treatment of end-stage IPAH to permit decompression of the suprasystemic right ventricle by right to left shunting, with preservation of upper body oxygenation. The shunt has the potential to delay the need for lung transplantation and offer a treatment for those who are transplant ineligible. To optimize shunt design and avoid the potential complications of bidirectional shunting, we developed a novel approach using a unidirectional-valved shunt (UVS) in patients with IPAH with suprasystemic pulmonary arterial pressure and poor right ventricular function. ⋯ The UVS may offer an alternative solution to lung transplantation in adolescents and young adults with IPAH. Longer-term follow-up is needed to determine the ultimate impact of unidirectional unloading of the right ventricle in these patients and to determine whether the UVS will enable a broader approach to the treatment of patients with IPAH.
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J. Thorac. Cardiovasc. Surg. · Apr 2021
Optimum surgical treatment for tricuspid valve infective endocarditis: An analysis of the Society of Thoracic Surgeons national database.
The incidence of intravenous drug-associated tricuspid valve endocarditis in the United States is rapidly increasing. Our goal was to evaluate the outcomes of isolated tricuspid valve operations using the Society of Thoracic Surgeon Adult Cardiac Surgical Database. ⋯ This contemporary series of intravenous drug-associated tricuspid valve endocarditis reveals that valvectomy is an independent predictor of operative mortality. When anatomically possible, repair should be the preferred management for tricuspid valve endocarditis to avoid recurrent valve infection and prosthetic valve degeneration.
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J. Thorac. Cardiovasc. Surg. · Apr 2021
Editorial CommentCommentary: If only we knew when we would fail.