The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2015
EditorialIs the air in Toronto, Rochester, and Cleveland different from that in London, Monaco, Leiden, Genk, Milan, and New York?
The tricuspid valve has been recently referred to as the "forgotten valve," because one now realizes that tricuspid regurgitation is bad for the patient and that reoperation for progressive tricuspid regurgitation after a left-sided valvular correction still carries a high mortality risk. However, the indication for concomitant tricuspid valve repair during a mitral valve repair procedure is still controversial, as illustrated by the reaction of Dr T. David to the presentation of Dr Chikwe and colleagues at the 2015 American Association for Thoracic Surgery meeting. ⋯ An annular dilation of 40 mm or 21 mm/m(2) has been proposed and validated by many authors. The preoperative functional class also plays a major role. Tricuspid regurgitation is a progressive disease, but the presence of a concomitant mitral valve disease may aggravate annular dilation; therefore, the earlier we operate on the mitral valve, the less frequently patients will require concomitant tricuspid valve repair.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Effects of small platform catheter-based left ventricular assist device support on regional myocardial signal transduction.
Left ventricular (LV) assist device (LVAD) support reduces pathological loading. However, load-induced adaptive responses may be suppressed. Pathological loading dysregulates cardiac G protein-coupled receptor (GPCR) signaling. Signaling through G proteins is deleterious, whereas beta (β)-arrestin-mediated signaling is cardioprotective. We examined the effects of pathological LV loading/LV dysfunction and treatment via LVAD, on β-arrestin-mediated signaling, and genetic networks downstream of load. ⋯ LVAD support inhibited cardioprotective β-arrestin-mediated signaling. However, net benefits of normalization of load-induced GPCR signaling were observed in the MI-adjacent zone. These findings may have implications for the optimal extent and duration of unloading, and for the development of adjunctive medical therapies.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Brahma-related gene 1 inhibits proliferation and migration of human aortic smooth muscle cells by directly up-regulating Ras-related associated with diabetes in the pathophysiologic processes of aortic dissection.
To elucidate the mechanisms of Brahma-related gene 1 (Brg1) involvement in the pathophysiologic processes of aortic dissection. ⋯ Our study illustrated that Brg1 inhibited the proliferation and migration capacity of HASMCs, via the mechanism of direct up-regulation of RRAD, thus playing an important role in the pathophysiologic processes of aortic dissection.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Comparative StudyEarly surgical intervention versus watchful waiting and outcomes for asymptomatic severe aortic regurgitation.
The management of asymptomatic patients with severe aortic regurgitation remains controversial. Accordingly, the aim of the present study was to assess the long-term outcomes and incidence of cardiac complications among asymptomatic patients with severe aortic regurgitation who underwent operation early, in the absence of any class I or class IIa guideline triggers, or were managed conservatively and eventually underwent operation whenever these triggers appeared. ⋯ Our results show that the outcome of asymptomatic patients with severe aortic regurgitation is not different between an early surgical and a more conservative strategy, provided that the conservatively managed patients are regularly followed up and timely referred to surgery as soon as operative triggers develop. This suggests that surgery should not be recommended in patients with aortic regurgitation who do not meet current guidelines for intervention.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Stented elephant trunk procedure with left subclavian artery transposition for acute type B dissection with distal arch involvement.
Complete or partial supra-aortic debranching, after thoracic endovascular aortic repair, is appealing treatment for complicated acute type B dissection (ABAD) with aortic arch involvement (AAI) because of reduced surgical trauma. However, unsatisfactory outcomes have been reported. We retrospectively reviewed our experience of left subclavian artery (LSCA) transposition with stented elephant trunk (SET) implantation for complicated ABAD with distal AAI. ⋯ This method preserves autologous brachiocephalic vessels, excludes the false lumen, promotes thrombosis and remodeling of the distal aorta, and repairs proximal aortic lesions simultaneously. Satisfactory surgical outcomes and follow-up results were achieved using LSCA transposition with SET implantation.