The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Review Meta AnalysisWorse long-term survival after off-pump than on-pump coronary artery bypass grafting.
To determine whether off-pump coronary artery bypass grafting (CABG) is associated with worse long-term survival compared with on-pump CABG. We performed a meta-analysis of adjusted observational studies and randomized controlled trials. ⋯ A meta-analysis of 22 studies, enrolling a total of >100,000 patients, showed that off-pump CABG is likely associated with worse long-term (≥5-year) survival compared with on-pump CABG.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Review Meta AnalysisMitral valve surgery: right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis.
To update the current evidence on mitral valve surgery through a lateral minithoracotomy versus median sternotomy. ⋯ MIVS and conventional mitral valve surgery have a similar perioperative outcome. Mitral valve surgery via a right lateral minithoracotomy seems to be favorable with regard to resource-related outcome.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Long-term outcomes of artificial chordal replacement with tourniquet technique in mitral valve repair: a single-center experience of 700 cases.
Artificial chordal replacement has been shown to be effective and durable, with numerous techniques reported. However, the outcomes of each technique have remained poorly defined. We report the long-term outcomes of the tourniquet technique. ⋯ The tourniquet technique is a simple and effective method to repair leaflet prolapse, with a low incidence of recurrent prolapse. The incidence of recurrent MR was high in the anterior leaflet prolapse group. Age, no annuloplasty ring or band, and residual MR were strong predictors of recurrent MR.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation: what is the operative risk?
There are limited data defining the risk of repeat sternotomy for surgical aortic valve replacement in octogenarian patients with aortic valve stenosis and previous coronary artery bypass graft operation. Our study assesses the risk of operation. ⋯ Repeat sternotomy and surgical aortic valve replacement can be done with low risk in octogenarian patients with previous coronary artery bypass graft operation.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Combined endovascular and surgical approach for aortobronchial fistula.
The perioperative outcomes of the endovascular approach to aortobronchial fistula have been favorable. However, it is uncertain whether thoracic endovascular aneurysm repair (TEVAR) alone provides a complete and durable cure for an aortobronchial fistula. TEVAR does nothing to address the issue of the defect in the respiratory tract, leaving the patient at risk of aortobronchial fistula recurrence and/or stent graft infection. The authors believe that the bronchial defect should be addressed. ⋯ Emergency TEVAR for an aortobronchial fistula is an appealing strategy for this devastating complication. However, to achieve a lasting result, direct contact between the stent graft and the pulmonary tissue should be avoided to prevent further erosive damage. Concomitant or staged repair should entail primary repair or resection and anastomosis of the bronchus and/or pulmonary resection with coverage of the stent graft using muscle or pleural flaps combined with broad-spectrum intravenous antibiotic therapy. Long-term surveillance and continued investigation are warranted.