The Journal of thoracic and cardiovascular surgery
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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
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 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
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.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter StudyTotal arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival.
We sought to evaluate our experience with total arterial revascularization and compare it with the traditional approach of a single internal thoracic artery supplemented by saphenous veins. ⋯ This large multicenter study suggests that a strategy of total arterial revascularization is associated with improved long-term survival compared with the use of only a single arterial and saphenous vein grafts. Total arterial revascularization should be encouraged in patients with a reasonable life expectancy.