The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Comparative StudyUse of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock-Taussig and right ventricle-pulmonary artery shunts for hypoplastic left heart syndrome.
Stage one reconstruction (Norwood operation) for hypoplastic left heart syndrome can be performed with either a modified Blalock-Taussig shunt or a right ventricle-pulmonary artery shunt. Both methods have certain inherent characteristics. It is postulated that mathematic modeling could help elucidate these differences. ⋯ The close correlation between predicted and observed data supports the use of mathematic modeling in the design and assessment of surgical procedures. The potentially damaging effects of a systemic ventriculotomy in the right ventricle-pulmonary artery shunt modification of the Norwood operation have not been analyzed.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Randomized Controlled TrialA prospective randomized trial comparing completion technique of fissures for lobectomy: stapler versus precision dissection and sealant.
Alveolar air leaks are common after pulmonary resection, often prolonging hospitalization and increasing surgical morbidity and costs. Air leakages result from lung tissue traumatized by the dissection of fissures. This randomized and controlled trial evaluates 2 different surgical techniques for the completion of interlobar fissures during pulmonary lobectomy to establish which is superior in preventing air leakage. ⋯ The use of electrocautery dissection and collagen patches coated with human fibrinogen and thrombin (TachoSil, Nycomed, Vienna, Austria) for aerostasis to complete interlobar fissures seems to be safe and effective in reducing alveolar air leaks and procedure costs. Although this pilot study showed advantages in terms of hospitalization and cost benefits, further multicentric studies are required to clarify that these differences are statistically significant.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Sinus node dysfunction after repair of partial anomalous pulmonary venous connection.
Sinus node dysfunction is known as a major complication after repair of partial anomalous pulmonary venous connection. We retrospectively analyzed the results of the atrial wall flap technique compared with the results of patch repair or direct suturing in the intra-atrial tunnel technique. ⋯ The atrial flap technique, which requires incision or suture crossing the crista terminalis, could cause sinus node dysfunction, whereas the intra-atrial rerouting method with a patch or direct suture maintains normal sinus node function postoperatively.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Randomized Controlled Trial Comparative StudyA prospective randomized comparison of the Medtronic Advantage Supra and St Jude Medical Regent mechanical heart valves in the aortic position: is there an additional benefit of supra-annular valve positioning?
The aim of this prospective randomized trial was to evaluate the impact of complete supraannular positioning of mechanical aortic bileaflet valves. ⋯ By grouping the data on the basis of a patient's tissue annulus diameter, no significant superiority of either prosthesis was detected with regard to left ventricular mass regression, effective orifice area index, and mean pressure gradient during rest and exercise. We conclude that there is no additional benefit of supraannular valve positioning.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Cardiac surgery in adults performed at children's hospitals: trends and outcomes.
The number of adults with congenital heart disease who require cardiac surgery is projected to increase dramatically. Controversy exists as to whether such procedures should be performed in pediatric centers, which generally have the greatest experience with operations for congenital heart disease. We sought to report the outcomes for cardiac surgery performed in adults (>or=21 years of age) at children's hospitals and determine how these practices varied among institutions. ⋯ A significant number of adult cardiac surgical procedures are being performed at children's hospitals with excellent results. The majority of procedures are not related to complex shunt lesions but rather pacemaker/defibrillator implantation and semilunar valve surgery. Whether adult patients with congenital heart disease should continue to undergo most cardiac surgery in children's hospitals is worthy of discussion.