The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Dec 2012
Editorial Review Meta AnalysisSystematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases.
Available data on clinical outcomes of hybrid aortic arch repair are limited, especially for patients with aortic dissection. The objective of this review was to provide pooled analysis of periprocedural mortality and neurologic outcomes in hybrid procedures involving the aortic arch for dissection and other aortic diseases. ⋯ Hybrid repair of the aortic arch carries not negligible risks of perioperative mortality and neurologic morbidity. Risk of neurologic complications has decreased with timing and center volume and may be limited in dissection repairs. However, contemporary information on aortic hybrid arch procedures is mainly provided by small case series or retrospective studies with wide range of results.
-
J. Thorac. Cardiovasc. Surg. · Dec 2012
Randomized Controlled Trial Comparative StudyA prospective, randomized comparison of 3 contemporary bioprosthetic aortic valves: should hemodynamic performance influence device selection?
Latest generation biologic aortic valve prostheses were designed to improve hemodynamic performance. We sought to determine whether there are clinically important early differences among these devices. ⋯ This prospective, randomized comparison reveals that there are small but consistent early postoperative hemodynamic differences among current third-generation porcine and pericardial aortic valve prostheses. The 3 valves studied performed equally well in patients with a small (≤21 mm) aortic annulus. The Magna valve had a slightly lower mean gradient in those with larger annular size (>23 mm). Longitudinal follow-up of these randomized cohorts is essential to determine late clinical implications of these early postoperative findings.
-
J. Thorac. Cardiovasc. Surg. · Dec 2012
Randomized Controlled Trial Comparative StudyResponse of mean arterial pressure to temporary biventricular pacing after chest closure during cardiac surgery.
We have previously demonstrated that biventricular pacing increased cardiac output within 1 hour of weaning from cardiopulmonary bypass in selected patients. To assess the possible sustained benefit, we reviewed in the present study the effects of biventricular pacing on the mean arterial pressure after chest closure. ⋯ Temporary biventricular pacing improves the hemodynamics after chest closure, with effects similar to those within 1 hour of bypass. Individualized optimization of atrioventricular delay is warranted, because the optimal delay was longer in 80% of our patients than the current recommendations for temporary postoperative pacing.
-
J. Thorac. Cardiovasc. Surg. · Dec 2012
Randomized Controlled Trial Comparative StudyLow-flow antegrade cerebral perfusion attenuates early renal and intestinal injury during neonatal aortic arch reconstruction.
Deep hypothermic circulatory arrest (DHCA) and antegrade cerebral perfusion (ACP) are 2 cardiopulmonary bypass strategies mainly used in aortic arch reconstructions. It has been suggested that during ACP, abdominal organs are better protected than during DHCA owing to partial perfusion via collaterals. We tested this hypothesis using intraoperative near-infrared spectroscopy (NIRS), lactate measurements, and biomarkers for early abdominal injury in neonates undergoing complex aortic arch repair. ⋯ These results substantiate earlier suggestions that ACP provides more abdominal organ protection than DHCA in neonates undergoing aortic arch reconstruction.