The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2023
ReviewAortic root replacement in the setting of a mildly dilated nonsyndromic ascending aorta.
There is controversy on how to address mild aortic root dilation during concomitant aortic valve replacement: composite aortic valve conduit replacement or separate ascending aorta and aortic valve replacement. We reviewed our experience to address the issue. ⋯ In patients with mild aortic root dilation, separate ascending aorta and aortic valve replacement results in a similar risk of repeat operation and mortality in comparison with composite aortic valve replacement. Separate ascending aorta and aortic valve replacement is not associated with subsequent aortic root dilation on medium-term echocardiography follow-up.
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J. Thorac. Cardiovasc. Surg. · Oct 2023
Racial/ethnic differences persist in treatment choice and outcomes in isolated intervention for coronary artery disease.
Studies have noted racial/ethnic disparities in coronary artery disease intervention strategies. We investigated trends and outcomes of coronary artery disease treatment choice (coronary artery bypass grafting or percutaneous coronary intervention) stratified by race/ethnicity. ⋯ In this contemporary national analysis, risk-adjusted frequency of coronary artery bypass grafting versus percutaneous coronary intervention for coronary artery disease differed by race/ethnicity. African American patients had lower odds of undergoing coronary artery bypass grafting and worse outcomes. Reasons for these differences merit further investigation to identify opportunities to reduce potential disparities.
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J. Thorac. Cardiovasc. Surg. · Oct 2023
Femoral artery cannulation increases the risk of postoperative stroke in patients with acute DeBakey I aortic dissection.
The selection of different arterial cannulation site influences the incidence of postoperative stroke in patients with DeBakey I acute aortic dissection. The study aimed to explore the optimal arterial cannulation for these patients. ⋯ Axillary artery only cannulation is recommended as the optimal arterial cannulation strategy for most patients with DeBakey I acute aortic dissection. For those patients who are not suitable for axillary artery only cannulation, axillary combined with femoral artery cannulation is not recommended.
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J. Thorac. Cardiovasc. Surg. · Oct 2023
Tailored approach and outcomes of aortic arch reconstruction after acute type A dissection repair.
After limited root/ascending with or without hemiarch repair for acute type A aortic dissection (ATAAD), 20% to 30% of patients require distal reintervention, frequently for arch pathology. In this report, we describe an institutional algorithm for arch management after previous limited ATAAD repair and detail operative and long-term outcomes. ⋯ Aneurysmal degeneration of residual arch dissection after limited ATAAD repair presents a complex reoperative challenge. An algorithmic operative approach tailored to patient anatomy and comorbidities yields excellent early and late outcomes, which continue to improve with increasing institutional experience.