The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2006
Reoperation is not an independent predictor of mortality during aortic valve surgery.
Reoperations on aortic valves are associated with increased mortality, which may affect valve prosthesis selection at the time of initial aortic valve replacement. We analyzed our experience to determine whether reoperation itself independently predicts mortality during aortic valve surgery. ⋯ The risk of mortality during aortic valve surgery is due mostly to active endocarditis, New York Heart Association class, and comorbidity. We failed to find a significant effect of reoperation on perioperative mortality. Mechanical valves, with their attendant anticoagulation-related morbidity, should not be implanted solely because of anticipated high mortality associated with bioprosthetic rereplacement.
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J. Thorac. Cardiovasc. Surg. · Feb 2006
Near-infrared spectroscopy to monitor cerebral oxygen saturation in single-ventricle physiology.
Near-infrared spectroscopy monitors cerebral oxygen saturation. This parameter parallels jugular venous oxygen saturation and reflects the balance between cerebral oxygen supply and demand. Experience with near-infrared spectroscopy in univentricular physiology is limited. This study explores the relationship between cerebral oxygen saturation, jugular venous oxygen saturation, and other variables of cerebral perfusion in a model of univentricular physiology. ⋯ This study shows that in univentricular physiology cerebral oxygen saturation correlates well with jugular venous oxygen saturation, arterial oxygen saturation, and arterial oxygen content. However, our findings suggest that in singe-ventricle physiology changes in cerebral oxygen saturation need to be interpreted in the context of changes in arterial oxygenation.
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J. Thorac. Cardiovasc. Surg. · Feb 2006
Duration of inotropic support after left ventricular assist device implantation: risk factors and impact on outcome.
Because duration of inotropic support after left ventricular assist device implantation has been recognized as a surrogate for right ventricular dysfunction, we sought to (1) identify its preimplantation risk factors, particularly its association with preimplantation right ventricular dysfunction, and (2) assess its impact on clinical outcomes. ⋯ Duration of inotropic support after left ventricular assist device insertion is strongly correlated with low preimplantation right ventricular stroke work index. In turn, it was associated with reduced survival to transplantation. Thus, right ventricular stroke work measured before implantation might be useful in decision making for biventricular support, destination therapy, or total artificial heart.