The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter StudyEffect of feeding modality on interstage growth after stage I palliation: a report from the National Pediatric Cardiology Quality Improvement Collaborative.
Achieving adequate growth after stage 1 palliation for children with single-ventricle heart defects often requires supplemental nutrition through enteral tubes. Significant practice variability exists between centers in the choice of feeding tube. The impact of feeding modality on the growth of patients with a single ventricle after stage 1 palliation was examined using the multiinstitutional National Pediatric Cardiology Quality Improvement Collaborative data registry. ⋯ In this large multicenter cohort, interstage growth improved for all groups and did not differ by feeding modality. With appropriate caloric goals and interstage monitoring, adequate growth may be achieved regardless of feeding modality and therefore local comfort and complication risk should dictate feeding modality.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter Study Observational StudyCompleteness of coronary revascularization and survival: Impact of age and off-pump surgery.
We conducted a multicenter observational cohort study of the effect of completeness of revascularization on long-term survival after coronary artery bypass grafting. We also investigated the impact of age and off-pump surgery. ⋯ Incomplete revascularization is associated with decreased long-term survival, even in elderly patients. Surgeons should consider these findings when choosing a revascularization strategy, particularly if off-pump coronary artery bypass grafting is contemplated.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
High basal level of autophagy in high-altitude residents attenuates myocardial ischemia-reperfusion injury.
Hypoxia can induce autophagy, which plays an important role in cardioprotection. The present study tested the hypothesis that patients with congenital heart disease living at a high altitude could resist ischemia-reperfusion injury better than those at a low altitude, through elevated basal autophagy by chronic hypoxia. ⋯ Patients living at a high altitude with congenital heart disease resisted ischemia-reperfusion injury during cardiac surgery better than those at a low altitude, possibly through elevated basal autophagy induced by chronic hypoxia.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter StudyGlobal experience with an inner branched arch endograft.
Branched endografts are a new option to treat arch aneurysm in high-risk patients. ⋯ Thoracic IDE NCT00583817, FDA IDE# 000101.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Comparative StudyMitral valve annuloplasty and anterior leaflet augmentation for functional ischemic mitral regurgitation: quantitative comparison of coaptation and subvalvular tethering.
Although restrictive mitral annuloplasty (RMA) has been the preferred surgical treatment of functional ischemic mitral regurgitation (FIMR), some patients with severely dilated left ventricles will experience recurrent mitral regurgitation (MR). Consequently, new surgical strategies have been entertained to compensate for severely dilated ventricles by maximizing coaptation and reducing subvalvular tethering. Anterior leaflet augmentation (ALA) with mitral annuloplasty has been theorized to meet these goals. We compared the mechanistic effects of RMA and adjunct ALA in the setting of FIMR. ⋯ A large ALA procedure created the greatest coaptation and reduced chordal tethering. Although all repairs abolished MR acutely, the repairs that create the greatest coaptation might conceivably produce a more robust and lasting repair in the chronic stage. A clinical need still exists to best identify which patients with altered mitral valve geometries would most benefit from an adjunct procedure or RMA alone.