The Journal of thoracic and cardiovascular surgery
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It is well known that hyperoxia can be potentially harmful to the ventilated patient, although little is known about the potential effects in the setting of lung reperfusion. We hypothesized that hyperoxic ventilation at the time of reperfusion could worsen the effects of lung reperfusion injury. ⋯ Ventilating lungs with 100% fraction of inspired oxygen at the time of reperfusion could increase the risk of lung reperfusion injury at the time of transplantation. Thus the patient should be ventilated with as low a fraction of inspired oxygen as possible to achieve adequate oxygen saturations during this critical reperfusion period.
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J. Thorac. Cardiovasc. Surg. · Nov 2005
Clinical outcomes in patients with chronic congestive heart failure who undergo left ventricular assist device implantation.
The use of left ventricular assist devices as a bridge to transplantation for patients with chronic congestive heart failure is well accepted. However, few studies have examined outcomes solely for these patients. This study details one center's left ventricular assist device experience with this population. ⋯ Among patients with chronic congestive heart failure, advanced age, female sex, diabetes, and low preoperative albumin predict poor clinical course. Careful risk stratification and comprehensive evaluation by care providers should be performed for candidates who are female, are elderly, and have diabetes, and preoperative nutritional optimization should be encouraged to enhance patient outcomes.
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J. Thorac. Cardiovasc. Surg. · Nov 2005
Comparative StudyA comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse.
We sought to compare the clinical and echocardiographic outcomes of mitral valve repair for mitral regurgitation in patients with degenerative disease of the mitral valve with posterior, anterior, or bileaflet prolapse. ⋯ The pathophysiology of mitral regurgitation affects the durability of mitral valve repair for degenerative disease, and the results of posterior prolapse are better than those of anterior and bileaflet prolapse. This study indicates that rates of reoperation underscore the rates of failure of mitral valve repair.
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J. Thorac. Cardiovasc. Surg. · Oct 2005
Does a bidirectional Glenn shunt improve the oxygenation of right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum?
There is a risk of myocardial ischemia in patients with pulmonary atresia and intact ventricular septum associated with the right ventricle-dependent coronary circulation. In this patient group, the oxygen delivery to the myocardium depends on the oxygen saturation of the right ventricular cavity. We hypothesized that bidirectional Glenn shunt would improve the oxygenation of right ventricle-dependent coronary circulation relative to a systemic-pulmonary artery shunt. The reduction of systemic venous return to the right atrium due to a bidirectional Glenn shunt could increase the oxygen saturation of the right ventricle in the clinical setting, when the mixture of systemic and pulmonary venous blood is unchanged at the atrial level. ⋯ Early bidirectional Glenn shunt could prevent progression of myocardial ischemia in pulmonary atresia with intact ventricular septum with right ventricle-dependent coronary circulation.
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J. Thorac. Cardiovasc. Surg. · Oct 2005
In vitro evaluation of aortic valve prosthesis in a novel valved conduit with pseudosinuses of Valsalva.
This study was undertaken to determine whether the presence of vortices immediately above a prosthetic aortic valve could negatively influence the in vitro hydrodynamic performances of a biologic or mechanical valve implanted in a new Dacron polyester fabric conduit that incorporates sculpted sinuses of Valsalva. ⋯ The normal opening and closing behavior of a prosthetic aortic valve was not altered or modified by a different root shape above the heart valve. The presence of vortices inside the pseudosinuses of Valsalva did not influence the hydrodynamic properties of the biologic and mechanical valves tested.