The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyModified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow.
The modified Blalock-Taussig shunt is the most commonly used palliative procedure for infants with ductal-dependent pulmonary circulation. Recently, catheter-based stenting of the ductus arteriosus has been used by some centers to avoid surgical shunt placement. We evaluated the durability and safety of ductal stenting as an alternative to the modified Blalock-Taussig shunt. ⋯ Freedom from reintervention to maintain adequate pulmonary blood flow was similar between infants undergoing modified Blalock-Taussig shunt or ductal stenting as an initial palliative procedure. However, a greater percentage of shunted patients experienced procedure-related complications and distal branch pulmonary artery stenosis. Palliative ductal stenting appears to be a safe and effective alternative to modified Blalock-Taussig in selected infants.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Outcomes of extracorporeal life support for low cardiac output syndrome after major cardiac surgery.
Extracorporeal life support (ECLS) is a widely accepted modality for the treatment of postoperative low cardiac output syndrome (LCOS) after major cardiac surgery by providing temporary circulatory support for the stunned myocardium. We sought to identify the factors that affect outcomes of ECLS for postoperative LCOS. ⋯ High lactate level before ECLS is an independent predictor of mortality after ECLS, necessitating earlier ECLS implementations before profound lactic acidosis develops. Moreover, nafamostat mesilate should be considered as alternative to heparin to reduce the risk of bleeding in these high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years.
Previous work in our institution has indicated that the Technical Performance Score (TPS) is highly associated with early outcomes in select subsets of procedures and age groups. We hypothesized that the TPS could predict early outcomes in a wide range of diagnoses and age groups. ⋯ The TPS is strongly associated with early outcomes across a wide range of ages and disease complexity and can serve as important tool for self-assessment and quality improvement.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices.
A competent aortic valve is essential to providing effective left ventricular assist device support. We have adopted a practice of central aortic valve closure by placing a simple coaptation stitch at left ventricular assist device implantation in patients with significant aortic insufficiency. We conducted a follow-up study to evaluate the efficacy and durability of this procedure. ⋯ The results of our study have shown that repair of aortic insufficiency with a simple central coaptation stitch is effective and durable in left ventricular assist device-supported patients, with follow-up extending into 2 years. Although aortic insufficiency progressed over time in those with minimal native valve regurgitation initially, no such progression was noted in those with central aortic valve closure. Additional investigation is needed to evaluate whether prophylactic central aortic valve closure should be performed at left ventricular assist device implantation to avoid problematic aortic regurgitation developing over time, in particular in patients undergoing left ventricular assist device implantation for life-long (destination therapy) support.