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Source: The Annals of Thoracic Surgery

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Total 306 results found since Jan 2013.

Comparative Outcomes of Transcarotid and Trans-subclavian Transcatheter Aortic Valve Replacement
ConclusionsThe transcarotid and the trans-subclavian approaches have similar safety and efficacy outcomes. The transcarotid approach had a shorter procedure duration and a trend towards lower fluoroscopy duration and radiation exposure.
Source: The Annals of Thoracic Surgery - July 5, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Novel Formula to calculate 3-D Angle between Inflow Cannula and Device Body of HeartMate II LVAD
ConclusionsWe established a novel formula to mathematically calculate actual 3D angles between inflow cannula and device body of HeartMate II. The formula would help investigators to validate their findings of the relationship between 2D projected angle (from CXR) and device thrombosis.
Source: The Annals of Thoracic Surgery - June 27, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Repair of Kommerell’s Diverticulum
ConclusionsOpen and endovascular approaches have a high success rate and low mortality risk. Selection of the specific type of intervention should be based on patient’s anatomy, additional needed procedures, and comorbid conditions.
Source: The Annals of Thoracic Surgery - June 27, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Preoperative anemia and outcomes in cardiovascular surgery: systematic review and meta-analysis
ConclusionsPreoperative anemia is associated with adverse outcomes following cardiac surgery. These findings support the addition of preoperative anemia to future risk prediction models, and as a target for risk modification.
Source: The Annals of Thoracic Surgery - June 23, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Steps forward in minimally invasive cardiac surgery: 10-year experience
ConclusionsThe present study shows the considerable and attractive results of our decision making process based on the tailored approach: the 10-year outcome analysis demonstrates a trend toward a progressive decrease in the overall rate of post-operative complications and a significant protective effect of the tailored approach on the occurrence of stroke.
Source: The Annals of Thoracic Surgery - June 23, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Deficit After Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis
ConclusionsAtherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphologic characteristics appear to be mandatory. Anticoagulation therapy should be performed carefully to avoid intracranial hemorrhagic changes.Visual Abstract
Source: The Annals of Thoracic Surgery - June 20, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Reversal and Resumption of Antithrombotic Therapy in LVAD-Associated Intracranial Hemorrhage
ConclusionsReversal of anticoagulation appears safe after LVAD-associated intracranial hemorrhage, though inadequate reversal was common. Resumption of warfarin ± antiplatelet was associated with fewer fatal and nonfatal thrombotic events compared with antiplatelets alone, though more nonfatal hemorrhage events occurred.
Source: The Annals of Thoracic Surgery - June 20, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Characterizing Risks Associated with Mitral Annular Calcification in Mitral Valve Replacement
ConclusionsThe presence of MAC alone, regardless of severity, was independently associated with increased operative mortality and adverse postoperative outcomes. Even after adjusting for attendant cardiovascular and metabolic comorbidities, centers with low MV case volumes were found to have worse outcomes after MVR.Graphical abstract
Source: The Annals of Thoracic Surgery - June 15, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Model for End-Stage Liver Disease Score Independently Predicts Mortality in Cardiac Surgery
ConclusionsIncreasing MELD score, international normalized ratio, and bilirubin all independently increase risk of operative mortality. Because high rates of missing data currently limit utilization of MELD, efforts to simplify and improve data collection would help improve future risk models.
Source: The Annals of Thoracic Surgery - May 23, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Outcomes in Aortic Arch Repair With Frozen Elephant Trunk Versus 2-Stage Hybrid Repair
ConclusionsBoth single-stage and 2-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined 2-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.
Source: The Annals of Thoracic Surgery - May 23, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Early Outcomes after Thoracoabdominal Aortic Aneurysm Repair with Hypothermic Circulatory Arrest
ConclusionsOur extended experience with this technique confirms its safety and effectiveness when used on a routine basis. The rates of spinal cord injury and permanent renal failure are among the lowest reported in the literature. Particularly favorable outcomes were observed in younger patients and those undergoing elective operations.
Source: The Annals of Thoracic Surgery - May 12, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Long-term outcomes with mechanical versus biological aortic valve prosthesis in patients >70 years
ConclusionsMechanical aortic valve prosthesis is associated with worse long-term survival and increased bleeding after SAVR in patients aged>70 years. Our results suggest caution when considering mechanical aortic valve prostheses in elderly patients.
Source: The Annals of Thoracic Surgery - May 12, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Preliminary results of debranch-first technique in Frozen Elephant Trunk procedures
ConclusionsFET with debranch-first technique is safe and feasible and resulted in low mortality and morbidity rates. Further investigation is needed to compare it with standard techniques.
Source: The Annals of Thoracic Surgery - May 11, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Impact of Preoperative Clopidogrel on Outcomes Following Coronary Artery Bypass Grafting
ConclusionsCABG can be safely performed in patients with recent Clopidogrel exposure with no increased risk of early or late mortality. However, CABG should be delayed for at least 5 days if clinically feasible to minimize transfusions and reoperation risk. In patients with more urgent indications, delaying CABG at least 3 days can mitigate but not eliminate the increased bleeding risk.
Source: The Annals of Thoracic Surgery - April 28, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Complications on Resource Utilization During 90-Day Coronary Artery Bypass Graft Bundle for Medicare Beneficiaries
ConclusionsMedicare beneficiaries who have adverse events during their index CABG hospitalization will significantly affect that hospital’s financial risk. The challenge under the voluntary CABG bundled payment program will be to monitor and reduce adverse events and manage the services consumed by Medicare beneficiaries having adverse events delivered at all the venues of care.
Source: The Annals of Thoracic Surgery - April 21, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Open Descending and Thoracoabdominal Aortic Repairs in Patients Younger than 50 Years Old
ConclusionsPatients under 50 years old with D/TAAA have low surgical risks and open repairs can be performed with excellent short-term and durable long-term results. Open surgical repairs should be considered initially in younger patients requiring D/TAAA repairs. HTAD warrants closer postoperative surveillance.
Source: The Annals of Thoracic Surgery - April 19, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Buffalo Trunk Technique for Aortic Arch Reconstruction
ConclusionsThe benefits of a hybrid approach to the frozen elephant trunk can be attained without the complex industry available technology as presented by our technique, the Buffalo Trunk. Evolution of this approach has facilitated shorter circulatory arrest time, and subsequently overall decreased operative times without compromising outcomes.
Source: The Annals of Thoracic Surgery - April 12, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Survival Following Myectomy for Obstructive Hypertrophic Cardiomyopathy-What Causes Late Mortality?
ConclusionsThis study, using two independent sources to verify vital status and cause of mortality, confirms that survival following septal myectomy is excellent. Hypertrophic cardiomyopathy was identified as the primary cause of death in less than 20%, with mortality in most patients unrelated to hypertrophic cardiomyopathy.
Source: The Annals of Thoracic Surgery - April 10, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Relationship of Aortic Stiffness to Exercise and Ventricular Volumes in Single Ventricles
ConclusionsSV patients with reconstructed aortas demonstrate increased aortic stiffness, increasing afterload on the ventricle. Native DAo stiffness distal to the reconstruction is inversely correlated with exercise performance, presumably to decrease impedance mismatch maintaining homogeneity of the aortic wall. This information suggests a possible mechanism for decreased exercise performance in SV patients with aortic reconstructions.
Source: The Annals of Thoracic Surgery - April 6, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Isolated Tricuspid Valve Surgery Have Improved in the Modern Era
ConclusionsIn the current era with careful patient selection and periprocedural management, isolated TV surgery can be performed with lower morbidity and mortality than has traditionally been reported with good long term survival. These outcomes can also serve as a benchmark for catheter-based tricuspid valve intervention outcomes.
Source: The Annals of Thoracic Surgery - April 2, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Tracheostomy After Thoracoabdominal Aortic Aneurysm Repair: Risk Factors and Outcomes
ConclusionsPatients who undergo tracheostomy after TAAA repair have a high risk of early and late mortality, as well as prolonged hospitalization. Strategies for improving survival outcomes in tracheostomy patients warrant investigation.
Source: The Annals of Thoracic Surgery - March 29, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Complete Sternal-Sparing HeartMate 3 Implantation: A Case Series of 10 Consecutive Patients
ConclusionsOur early outcomes suggest that the CSS approach may reduce the incidence of right ventricular failure, bleeding, intubation time, and intensive care unit length of stay. Further studies are needed to fully elucidate the advantages of CSS LVAD implantation compared with median sternotomy.
Source: The Annals of Thoracic Surgery - March 27, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Deep Hypothermia With Retrograde Cerebral Perfusion Versus Moderate Hypothermia With Antegrade Cerebral Perfusion for Arch Surgery
ConclusionsAlthough there was no significant difference in clinically evident neurologic injury, this pilot study suggests that MHCA+ACP may be associated with a higher incidence of radiographic neurologic injury than DHCA+RCP in patients undergoing elective hemiarch replacement.
Source: The Annals of Thoracic Surgery - March 27, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Physician-Modified Thoracic Stent-Grafts for the arch after surgical treatment of type A dissection
ConclusionsThe use of physician modified thoracic stent-grafts for the treatment of dissecting aortic arch aneurysm after surgical treatment of acute type A dissection is both feasible and effective. Durability concerns will need to be assessed in future studies.Graphical abstract
Source: The Annals of Thoracic Surgery - March 20, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Transcarotid Versus Transapical and Transaortic Access for Transcatheter Aortic Valve Replacement
ConclusionsTranscarotid compared to transapical and transaortic access for TAVR is associated with shorter length of stay, fewer transfusions, more frequent discharge to home and better 2-year survival.
Source: The Annals of Thoracic Surgery - March 15, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Continuous-Flow Left Ventricular Assist Device Survival Improves with Multidisciplinary Approach
ConclusionsImplementing a comprehensive multidisciplinary approach substantially improved outcomes for CF-LVAD recipients.
Source: The Annals of Thoracic Surgery - March 8, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Addition of Aortic Root Procedures during Elective Arch Surgery Does Not Confer Added Morbidity nor Mortality
ConclusionsThe addition of an aortic root procedure during elective aortic arch surgery lengthens cardiopulmonary bypass and aortic crossclamp times but does not increase postoperative morbidity nor mortality.
Source: The Annals of Thoracic Surgery - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Bleeding Revision on Outcomes after Left-Ventricular Assist Device Implantation
ConclusionsA bleeding revision is associated with significantly reduced survival and substantially increased morbidity during LVAD support. Pre-, intra- and post-operative prophylactic strategies may help to prevent this life-threatening complication.
Source: The Annals of Thoracic Surgery - March 6, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Risk Prediction Model for Major Adverse Outcome in Proximal Thoracic Aortic Surgery
ConclusionsThe current study identified risk factors for major adverse outcome after proximal thoracic aortic surgery with hypothermic circulatory arrest for degenerative pathology. The proposed simple, accurate model can quantify risk and facilitate physician-patient counseling before possible surgical intervention.
Source: The Annals of Thoracic Surgery - February 20, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Reversal and Resumption of Antithrombotic Therapy in LVAD- Associated Intracranial Hemorrhage
ConclusionsReversal of anticoagulation appears safe following LVAD-associated intracranial hemorrhage, though inadequate reversal was common. Resumption of warfarin±antiplatelet was associated with fewer fatal and non-fatal thrombotic events compared to antiplatelets alone, though more non-fatal hemorrhage events occurred.
Source: The Annals of Thoracic Surgery - February 12, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Deficit Following Aortic Arch Replacement: The Influence of the Aortic Atherosclerosis
ConclusionsAtherothrombotic lesions found by objectively graded computed tomography were predictors of neurologic deficit. Retrograde perfusion in the presence of a distal atherothrombotic lesion should be avoided whenever possible. Strategies based on the full assessment of the whole aortic morphology appear to be mandatory. Anticoagulation therapy should be performed very carefully to avoid intracranial hemorrhagic changes.Graphical abstract
Source: The Annals of Thoracic Surgery - January 31, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Feasibility and Outcomes of Transcatheter Aortic Valve Implantation Using the Left Axillary Artery as Primary Access Site
ConclusionsThis is the first study reporting outcome after transcatheter aortic valve implantation using the LAA as default access. We conclude that it is highly feasible and safe with low rates of major vascular complications, bleeding, and stroke.Visual Abstract
Source: The Annals of Thoracic Surgery - January 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Valve-Sparing Root Replacement Provides Excellent Midterm Outcomes for Bicuspid Valve Aortopathy
ConclusionsVSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of preoperative AI. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.Visual Abstract
Source: The Annals of Thoracic Surgery - January 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients
ConclusionsA prudent and diligent multifaceted early extubation protocol may be successful in high-risk cardiac surgical patients without an increase in adverse outcomes. A larger study is needed in the future to confirm the finding.
Source: The Annals of Thoracic Surgery - January 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Society of Thoracic Surgeons Intermacs Database Annual Report: Evolving Indications, Outcomes, and Scientific Partnerships
ConclusionsWith the evolution of MCS, patient phenotype and outcomes are also changing over time. CF LVAD support is increasingly being used in the less ill patient phenotype and more patients are supported for destination therapy. Mean survival is now approaching 5 years, but adverse events, especially neurologic events, continue to have a detrimental impact on the success of CF LVAD support.
Source: The Annals of Thoracic Surgery - January 26, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Model for End Stage Liver Disease Score Independently Predicts Mortality in Cardiac Surgery
ConclusionsIncreasing MELD score, INR, and bilirubin all independently increase risk of operative mortality. Since high rates of missing data currently limit utilization of MELD, efforts to simplify and improve data collection would help improve future risk models.
Source: The Annals of Thoracic Surgery - January 10, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

A Novel Toroidal-Flow Left Ventricular Assist Device Minimizes Blood Trauma: Implications of Improved Ventricular Assist Device Hemocompatibility
ConclusionsThe TORVAD design, with markedly lower shear stress and pulsatile flow, caused significantly less blood trauma that the HeartMate II. LVADs with reduced blood trauma are likely to improve clinical outcomes and expand LVAD therapy into patients with less advanced heart failure.
Source: The Annals of Thoracic Surgery - December 24, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Neurologic Outcomes in Aortic Arch Repair with Frozen Elephant Trunk versus Two-stage Hybrid Repair
ConclusionsBoth single-stage and two-stage hybrid arch replacements are effective approaches for treating complex aortic arch diseases. Early deaths and neurological outcomes in the single-stage group are comparable to those in the combined two-stage group. Furthermore, in this series, patients who had a single-stage hybrid procedure had a higher survival rate at 2 years.
Source: The Annals of Thoracic Surgery - December 20, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Totally Thoracoscopic Closure of the Left Atrial Appendage
This report describes a technique for totally thoracoscopic LAA exclusion with an epicardial clip device. This approach provides a safe and likely more effective alternative to LAA management than other endocardial devices.
Source: The Annals of Thoracic Surgery - December 14, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Complications on Resource Utilization during 90-day CABG Bundle for Medicare Beneficiaries
ConclusionsMedicare beneficiaries that experience adverse events during their index CABG hospitalization will significantly impact that hospital’s financial risk. The challenge under the voluntary CABG bundled payment program will be to monitor and reduce adverse events and managing the services consumed by Medicare beneficiaries experiencing adverse events delivered at all the venues of care.
Source: The Annals of Thoracic Surgery - December 14, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Association Between Red Blood Cell Transfusion and Clinical Outcomes Among Patients Undergoing Transcatheter Aortic Valve Replacement
ConclusionsPRBC transfusion in patients undergoing TAVR is associated with an increased incidence of adverse outcomes during hospitalization, at 30-day and 1-year follow-up.
Source: The Annals of Thoracic Surgery - December 13, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Successful heart transplantation in a patient with Loeys-Dietz Syndrome
Publication date: Available online 1 December 2018Source: The Annals of Thoracic SurgeryAuthor(s): Aliya G. Feroe, Amy G. Fiedler, David A. D’AlessandroAbstractOur patient is a 45-year-old woman with a history of Loeys-Dietz syndrome (LDS), vertebral artery dissection, stroke, prior atrial septal defect (ASD) repair, and spontaneous left main coronary artery dissection re-vascularized with coronary artery bypass grafting who progressed to end-stage heart failure. She was listed for cardiac transplantation and a suitable organ became available. She underwent heart transplantation over one year ago successfully. This is th...
Source: The Annals of Thoracic Surgery - December 2, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes after thoracic endovascular aortic repair with overstenting of the left subclavian artery
ConclusionsEvery 10th patient with LSA overstenting and no revascularization developed left arm malperfusion. No LSA revascularization, extensive aortic coverage with two or more endografts, and coronary artery disease increased the risk for permanent paraplegia, left-hemispherical stroke, and left arm malperfusion. Patients should undergo LSA revascularization to prevent left vertebral artery-associated central neurologic complications and to maintain upper-left extremity perfusion.
Source: The Annals of Thoracic Surgery - December 1, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Conventional open versus hybrid arch repair of aortic arch disease: early and long-term outcomes
ConclusionsIn the treatment of aortic arch diseases, HAR showed equivalent short-term outcomes compared with TAR but was limited regarding long-term outcomes beyond 5 years post-procedure. Conventional TAR remains the gold standard of therapy, and our findings suggest that the hybrid approach should be reserved for strictly selected patients with significant comorbidities.
Source: The Annals of Thoracic Surgery - December 1, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Endovascular Versus Open Repair For Chronic Type B Dissection Treatment: A meta-analysis
ConclusionsThis recent non -randomised data shows early ER benefit, unsustained at mid-term. Reintervention is higher after ER, necessitating improved technique. However, OS is exempt neither from reintervention nor rupture. Both techniques have their place, but patient selection is key.
Source: The Annals of Thoracic Surgery - November 25, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Fatal Neurologic Dysfunction During Continuous-flow Left Ventricular Assist Device Support
ConclusionsOur study elucidates the characteristics and risk factors of patients who died of ND during CF-LVAD support. Further studies are required to find ways to decrease the incidence of fatal ND during CF-LVAD support.
Source: The Annals of Thoracic Surgery - November 21, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Antithrombotic Strategies after Bioprosthetic Aortic Valve Replacement: A Systematic Review
ConclusionsTreatment with warfarin or aspirin both lead to similar outcomes after surgical bAVR. Combining aspirin with warfarin may lead to a small decrease in thromboembolism and mortality but is accompanied by increased bleeding. For TAVR patients, aspirin is equivalent to DAPT for reducing thromboembolism and mortality, with a possible decrease in bleeding.
Source: The Annals of Thoracic Surgery - November 18, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Prothrombin complex concentrate in cardiac surgery: A systematic review and meta-analysis
ConclusionsIn patients with significant bleeding following cardiac surgery, PCC administration seems to be more effective than FFP in reducing perioperative blood transfusions. No additional risks of thromboembolic events or other adverse reactions were observed. Randomized controlled trials are needed to definitively establish the safety of PCC in cardiac surgery.
Source: The Annals of Thoracic Surgery - November 18, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Salvage Coronary Artery Bypass Predicts Increased Mortality During Aortic Root Operation
ConclusionsCABG-R results in increased postoperative morbidity or mortality compared with isolated ROOT. Outcomes, however, are influenced by the specific clinical indication. CABG for coronary artery disease was associated with similar outcomes compared with isolated ROOT. Patients undergoing unplanned CABG for acute ventricular failure had the worst outcomes, thus underscoring the importance of technical success during coronary reimplantation.
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Clinical Leaflet Thrombosis in Transcatheter and Surgical Bioprosthetic Aortic Valves by Four-Dimensional Computed Tomography
ConclusionsOne-third of patients with clinical or echocardiographic indications suggestive of leaflet thrombosis were found to have evidence of leaflet thrombosis using 4DCT. This allowed tailored anticoagulation therapy with resolution of the thrombus in most patients and avoiding unnecessary anticoagulation in the remaining two-thirds of patients.Visual Abstract
Source: The Annals of Thoracic Surgery - November 16, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research