The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Comparative Study Observational StudyInsurance status predicts acuity of thoracic aortic operations.
Nonelective case status is the strongest predictor of mortality for thoracic aortic operations. We hypothesized that underinsured patients were more likely to require nonelective thoracic aortic surgery because of reduced access to preventative cardiovascular care and elective surgical services. ⋯ Underinsured patients were at the greatest risk of requiring nonelective thoracic aortic operation, possibly because of decreased use of lipid-lowering therapies and aortic surveillance. These data imply that greater access to preventative cardiovascular care may reduce the need for nonelective thoracic aortic surgery and lead to improved survival from thoracic aortic disease.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Multicenter StudyMyocardial damage influences short- and mid-term survival after valve surgery: a prospective multicenter study.
Myocardial damage occurs after valve surgery, but its prognostic implication has not been evaluated. The aim of the present study was to assess the influence of myocardial damage on mortality and morbidity in patients undergoing aortic surgery (AVS) and mitral valve surgery (MVS). ⋯ An elevated postoperative cTnI level was an independent risk factor for mortality and morbidity. Measurement of the cTnI level improved the risk reclassification of patients undergoing AVS or MVS.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Neurologic and psycho-intellectual outcome related to structural brain imaging in adolescents and young adults after neonatal arterial switch operation for transposition of the great arteries.
We studied brain structure abnormalities in adolescents and young adults who had undergone the neonatal arterial switch operation for transposition of the great arteries and related them to the neurologic and psycho-intellectual outcomes. ⋯ Despite encouraging overall neurodevelopmental outcomes, a significant minority had performances below the expected level, emphasizing the need for ongoing surveillance. Considering the high frequency of structural brain abnormalities, prospective long-term studies are needed to define their prognostic value with respect to the neuropsychological outcomes in childhood and adolescence.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Comparative Study Observational StudyIncreased late mortality after coronary artery bypass surgery complicated by isolated new-onset atrial fibrillation: a comprehensive propensity-matched analysis.
The association of new-onset postoperative atrial fibrillation (POAF) and late death after coronary artery bypass grafting (CABG) has been confounded by the frequent concomitant serious complications that co-occur with POAF. We aimed to define the magnitude and time dependence of the effect of isolated POAF on late survival after uncomplicated CABG to comprehensively account for comorbidity and perioperative confounding factors. ⋯ Isolated POAF was associated with a time-varying increase in mortality after CABG. Given these findings and the high incidence of POAF, efforts to reduce POAF should be pursued to potentially improve resource usage, morbidity, and mortality.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Comparative StudyEffect of aortic aneurysm replacement on outcomes after bicuspid aortic valve surgery: validation of contemporary guidelines.
Bicuspid aortic valve (BAV) disease is associated with aortic dilatation and aneurysm (AN) formation. The American College of Cardiology/American Heart Association (ACC/AHA) 2006 guidelines recommend replacement of the ascending aorta for an aortic diameter (AD)> 45 mm in patients undergoing aortic valve replacement (AVR). We evaluated the outcomes of AVR and AVR with aortic replacement (AVR/AN). ⋯ In patients with undergoing AVR, no increase was seen in morbidity or mortality when adding aortic replacement with an AD of 45 to 49 mm, in accordance with the 2006 ACC/AHA guidelines, although the AVR/AN AD≥50-mm group had a greater risk of respiratory complications. Our findings indicate that compliance with the ACC/AHA guidelines is safe in select centers.