The Journal of thoracic and cardiovascular surgery
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With advances in valve repair and ventricular recruitment strategies, patients initially palliated with single ventricle physiology have been increasingly brought to biventricular circulation. Few data are available on the technical aspects and outcomes after takedown of the superior cavopulmonary anastomosis (bidirectional Glenn [BDG]). We reviewed a single-institutional experience in BDG takedown. ⋯ BDG takedown can be undertaken with a low operative risk and a low incidence of SVC or pulmonary artery stenosis or sinus node dysfunction. Additional follow-up is required to see how the reconstructed SVC grows.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Concomitant aortic and mitral surgery: to replace or repair the mitral valve?
The study objectives were to evaluate the perioperative outcomes of concomitant mitral and aortic valve surgery and to determine the influence of mitral valve repair versus replacement on survival and adverse events. ⋯ Concomitant mitral and aortic valve surgery carries a low surgical risk. The choice of the mitral procedure did not significantly affect survival. However, mitral valve replacement was associated with an increased incidence of adverse events. Thus, valve repair, whenever feasible, is a better option.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Improving interstage survival after Norwood operation: outcomes from 10 years of home monitoring.
Infants who undergo Norwood stage 1 palliation (S1P) continue with high-risk circulation until stage 2 palliation (S2P). Routine care during the interstage period is associated with 10% to 20% mortality. This report illustrates the sustained reduction of interstage mortality over 10 years associated with use of home monitoring. ⋯ Home monitoring after S1P is associated with excellent interstage survival. Although a breach of monitoring criteria occurred in more than half of patients, our analysis failed to identify independent predictors of interstage events. Analysis of variables predicting mortality could not be assessed due to the low frequency of death in this cohort. Failure to identify specific variables for interstage events suggests that home monitoring, as part of an interstage surveillance program, should be applied to all S1P hospital survivors.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Long-term outcome of patients on continuous-flow left ventricular assist device support.
Recent advances in technology and improved patient management have enabled the use of mechanical circulatory support for unexpected long-term periods. Improved long-term outcomes may facilitate the use of device therapy as an alternative to heart transplantation. However, there are scarce data about the long-term outcomes of continuous-flow left ventricular assist devices. This study sought to evaluate the long-term outcomes in patients receiving continuous-flow left ventricular assist devices. ⋯ Current continuous-flow left ventricular assist devices can provide satisfactory long-term survival. However, rehospitalization is frequently required.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Clinical significance and determinants of the universal definition of perioperative bleeding classification in patients undergoing coronary artery bypass surgery.
We evaluated the clinical significance and identified the predictors of the universal definition of perioperative bleeding (UDPB) classes in patients undergoing isolated coronary artery bypass grafting (CABG). ⋯ High UDPB classes were associated with significantly poorer immediate and late outcomes. The UDPB classification seems to be a valuable research tool to estimate the severity of bleeding and its prognostic impact affect after coronary surgery.