The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center.
We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support. ⋯ We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Aortic Area/Height Ratio, Peak Wall Stresses, and Outcomes in Veterans with Tricuspid vs Bicuspid Aortic Valve Associated Ascending Thoracic Aortic Aneurysms.
In ascending thoracic aortic aneurysm risk stratification, aortic area/height ratio is a reasonable alternative to maximum diameter. Biomechanically, aortic dissection may be initiated by wall stress exceeding wall strength. Our objective was to evaluate the association between aortic area/height and peak aneurysm wall stresses in relation to valve morphology and 3-year all-cause mortality. ⋯ Area/height was more predictive of high circumferential stresses in bicuspid than tricuspid valve aneurysms, but similarly less predictive of high longitudinal stresses in both valve types. Peak longitudinal stress, not area/height, independently predicted all-cause mortality. VIDEO ABSTRACT.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Clinical utility of a deep-learning mortality prediction model for cardiac surgery decision making.
The aim of this study using decision curve analysis (DCA) was to evaluate the clinical utility of a deep-learning mortality prediction model for cardiac surgery decision making compared with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II and to 2 machine-learning models. ⋯ The deep-learning model had better predictive accuracy and greater clinical utility than the EuroSCORE II and the 2 machine-learning models. These findings suggest that deep learning with Tabular Bidirectional Encoder Representations from Transformers prediction model could be used in the future as the gold standard for cardiac surgery decision making.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Aortic Root Geometry following Composite Valve Graft Implantation - Implications for Future Valve-in-valve Procedures.
Biological composite valve grafts (CVGs) are being performed more frequently, which increases the need for interventions treating bioprosthetic valve failure. The feasibility of valve-in-valve procedures in this population is uncertain. This study aimed to assess changes in aortic root geometry and coronary height following CVG implantation to better understand future interventions. ⋯ Coronary height significantly decreased following CVG implantation. The majority of patients after bio-CVG were at a potential risk for coronary obstruction in future valve-in-valve procedures. Further studies are needed to identify the best possible technique for coronary reimplantation and other measures to diminish the risk for future coronary obstruction in this population.