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Source: The Annals of Thoracic Surgery

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Total 306 results found since Jan 2013.

Aggressive Aortic Arch and Carotid Replacement Strategy for Type A Aortic Dissection Improves Neurologic Outcomes
Conclusions An algorithmic approach to TAAD including (1) rapid transport-to-incision-to-cardiopulmonary bypass established centrally, (2) neurocerebral monitoring, (3) liberal use of total arch replacement for clearly defined indications (and hemiarch for all others), and (4) common carotid arterial replacement for concomitant carotid dissections significantly improves outcomes.
Source: The Annals of Thoracic Surgery - November 4, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification
Conclusions In patients with severe mitral annular calcification undergoing mitral valve surgery, complete annular decalcification and reconstruction yields favorable outcomes.
Source: The Annals of Thoracic Surgery - November 4, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection
Conclusions Moderate HCA with uSACP is an effective circulation management strategy that provides excellent cerebral and visceral protection during emergent ATAAD repair. In the setting of antegrade cerebral perfusion, deep hypothermia does not provide any additional benefit.
Source: The Annals of Thoracic Surgery - October 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

What Is the Role of Minimally Invasive Mitral Valve Surgery in High-Risk Patients? A Meta-Analysis of Observational Studies
Conclusions Minimally invasive mitral valve surgery is a safe and comparable alternative to standard sternotomy in patients at high risk, with similar early mortality and repair rate and better postoperative outcomes, although a longer cardiopulmonary bypass time is required.
Source: The Annals of Thoracic Surgery - October 24, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Intermediate Clinical and Hemodynamic Outcomes After Transcatheter Aortic Valve Implantation
Conclusions Our data show that TAVI has good early and intermediate-term clinical and hemodynamic outcomes in high-risk or inoperable patients with severe symptomatic aortic valve stenosis. PVL of any grade has a significant impact on survival.
Source: The Annals of Thoracic Surgery - October 24, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Aortic Root Replacement in Octogenarians Offers Acceptable Perioperative and Late Outcomes
Conclusions Octogenarians can safely undergo aortic root replacement with moderately worse but acceptable perioperative mortality and late survival. Further studies are necessary to determine which subset of octogenarians are at the highest operative risk and may benefit from a conservative approach.
Source: The Annals of Thoracic Surgery - October 17, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Predicted Risk of Mortality, Transfusion, and Postoperative Outcomes in Isolated Primary Valve Operations
Conclusions Increased PROM yielded higher risks of transfusion. Postoperative outcomes were worse in patients who received a transfusion. This study suggests that the association between transfusion and clinical outcomes may be partly explained by the higher PROM among patients who ultimately received transfusions.
Source: The Annals of Thoracic Surgery - October 17, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Is Conventional Open Repair Still a Good Option for Aortic Arch Aneurysm in Patients of Advanced Age?
Conclusions Even in patients older than 75 years, recent surgical results of conventional open arch repair were acceptable, especially in elective cases. Thus, conventional open surgical aortic arch replacement remains a good option, especially in patients with preserved renal function.
Source: The Annals of Thoracic Surgery - September 18, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Transcatheter Aortic Valve Replacement Versus Aortic Valve Bypass
Conclusions TAVR and AVB relieve aortic stenosis and have similar and acceptable procedural mortality rates. AVB-treated patients had 1.75 times the STS risk score when compared with the TAVR cohort. Hospital charges for TAVR were nearly twofold those of AVB. Hospital reimbursement was similar, but AVB had two to four times the profit margin of TAVR. Longer follow-up for the TAVR cohort will determine whether survival is comparable to that after AVB at 3 and 5 years.
Source: The Annals of Thoracic Surgery - September 12, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Left Subclavian Artery Fenestration: A Novel Treatment Strategy for Acute Type A Aortic Dissection
Conclusions The LSA fenestration technique during total arch replacement combined with stented elephant trunk implantation for acute type A aortic dissection is reliable and effective for patients who have no dissection at the LSA. Furthermore, because the simplified surgical procedure largely shortens the time of operation, it effectively improves the patient’s prognosis.
Source: The Annals of Thoracic Surgery - September 5, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes in Nonagenarians Undergoing Transcatheter Aortic Valve Replacement in the PARTNER-I Trial
Conclusions A TAVR can be performed in nonagenarians with acceptable short- and mid-term outcomes. Although TF- and TA-TAVR outcomes are not directly comparable, TA-TAVR appears to carry a higher risk of early death without a difference in intermediate-term mortality. Age alone should not preclude referral for TAVR in nonagenarians.
Source: The Annals of Thoracic Surgery - September 1, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Myocardial Protection During Aortic Arch Repair in a Piglet Model: Beating Heart Technique Compared With Crystalloid Cardioplegia
Conclusions The BH technique is associated with improved contractility compared with standard CC. There is comparable ischemic damage in both groups, with an earlier rise in blood levels of troponin T after BH and more fluctuation of serum electrolytes with CC. Evidence of ischemic changes should dissuade one from using the BH technique imprudently.
Source: The Annals of Thoracic Surgery - August 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contemporary Outcomes of Coronary Artery Bypass Grafting Among Patients With Insulin-Treated and Non–Insulin-Treated Diabetes
Conclusions Patients with diabetes undergoing CABG have substantially increased risk of major adverse events. Patients with ITDM represent an especially high-risk group.
Source: The Annals of Thoracic Surgery - August 25, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Effect of Institutional Volume on Complications and Their Impact on Mortality After Pediatric Heart Transplantation
Conclusions No association was observed between institutional volume and adjusted or unadjusted long-term survival. High-volume institutions have a significantly lower rate of postoperative complications after pediatric OHT. This association does not correlate with increased subsequent mortality in low-volume institutions. Given these findings, strategies integral to the allocation of allografts in adult transplantation, such as regionalization of care, may not be as relevant to pediatric OHT.
Source: The Annals of Thoracic Surgery - August 21, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures
Conclusions Mitral valve repair or replacement, including concomitant procedures, can be performed safely and effectively using the LEAR technique. With a dedicated robotic team, the vast majority of patients with MV disorders, either isolated or with concomitant problems, can be treated using the LEAR technique.
Source: The Annals of Thoracic Surgery - August 19, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter?
Conclusions For women, the advantage of CABG surgery over DES is very similar to what was found for men, and this advantage persisted for patients with and without high-risk characteristics.
Source: The Annals of Thoracic Surgery - August 18, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Open Repair of Mycotic Descending Thoracic and Thoracoabdominal Aortic Aneurysms
Conclusions Open repair of mycotic descending thoracic and thoracoabdominal aortic aneurysms remains the gold standard of therapy. Aggressive intraoperative debridement with in situ prosthetic reconstruction permits a high rate of success in this very high risk cohort of patients. Lifelong antibiotic suppression therapy may prevent late prosthetic graft infection.
Source: The Annals of Thoracic Surgery - August 14, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Is Total Arch Replacement Associated With Worse Outcomes During Repair of Acute Type A Aortic Dissection?
Conclusions Acute type A aortic dissection remains a challenge associated with significant mortality and morbidity. When compared with a less aggressive resection, total arch replacement performed in an individualized fashion can be associated with acceptable early and late outcomes for ATAAD and was not associated with worse outcomes.
Source: The Annals of Thoracic Surgery - August 11, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Midterm Outcome of Coronary Artery Bypass Grafting in Young Patients: A Multicenter Italian Study
Conclusions Patients less than 50 years of age undergoing CABG have an excellent outcome compared with elderly patients. These data indicate that despite its premature onset, coronary artery disease in young patients does not have a more aggressive course than that in older patients.
Source: The Annals of Thoracic Surgery - August 11, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Transapical and Transaortic Transcatheter Aortic Valve Replacement in the United States
Conclusions Patients undergoing TAo TAVR are older, more likely female, and have significantly higher STS predicted risk of mortality scores than patients operated on by TA access. There were no risk-adjusted differences between TA and TAo access in mortality, stroke, or readmission rates as long as 1 year after TAVR.
Source: The Annals of Thoracic Surgery - July 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

The Subclavian Intraaortic Balloon Pump: A Compelling Bridge Device for Advanced Heart Failure
Conclusions The SC-IABP provided excellent hemodynamic support with minimal morbidity and mortality, allowed for extensive rehabilitation, and permitted more than 90% of patients to receive their intended therapy. Therefore, SC-IABP is a compelling bridge device for patients with advanced congestive heart failure.
Source: The Annals of Thoracic Surgery - July 28, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Atrial Fibrillation Duration on the Success of First-Time Concomitant Cox Maze Procedures
Conclusions Longer AF duration significantly impacted CM success and may result from extensive tissue remodeling. Patients with longer AF duration can expect reasonable success rates, especially when on AAD, and low stroke rates during follow-up. Cryoablation may reduce AF duration impact on success compared with combined bipolar radiofrequency and cryothermia.
Source: The Annals of Thoracic Surgery - July 27, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contemporary Outcomes of Repeat Aortic Valve Replacement: A Benchmark for Transcatheter Valve-in-Valve Procedures
Conclusions Re-AVR is now performed with an acceptable operative mortality, which is higher than primary AVR. The overall incidence of stroke, vascular complication, and postoperative aortic insufficiency was low although higher than primary AVR. These results may serve as a benchmark for future analysis of valve-in-valve transcatheter aortic valve replacement and may have an effect on future choice of transcatheter aortic valve replacement vs re-AVR.
Source: The Annals of Thoracic Surgery - July 22, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Impact of Ultrafiltration on Kidney Injury After Cardiac Surgery: The Michigan Experience
Conclusions Patients exposed to CUF had a higher adjusted risk of AKI. Clinical teams should consider lower volumes of CUF among patients with low creatinine clearance to minimize the risk of AKI.
Source: The Annals of Thoracic Surgery - July 22, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency
Conclusions Robotic off-pump CABG using IMA grafts is a safe and effective procedure in selected patients. The long-term outcome and patency of IMA grafts are excellent.
Source: The Annals of Thoracic Surgery - July 18, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes for Transcatheter Aortic Valve Replacement in Nonagenarians
Conclusions Extreme-aged nonagenarian patients may have excellent outcomes from TAVR at 30-day and midterm follow-up. Alternative access TAVR is associated with higher morbidity and mortality than transfemoral TAVR. Referral for TAVR of nonagenarians should not be precluded based on age alone.
Source: The Annals of Thoracic Surgery - July 17, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Rewarming Rate During Cardiopulmonary Bypass Is Associated With Release of Glial Fibrillary Acidic Protein
Conclusions Rewarming rate during CPB was correlated with evidence of brain cellular injury documented with plasma GFAP levels. Modifying current practices of patient rewarming might provide a strategy to reduce the frequency of neurologic complications after cardiac surgery.
Source: The Annals of Thoracic Surgery - July 7, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Low Incidence of Paravalvular Leakage With the Balloon-Expandable Sapien 3 Transcatheter Heart Valve
Conclusions The present study shows excellent clinical and hemodynamic outcomes of high-risk transapical valve replacement patients treated with the new S3 THV. The S3 THV shows a low incidence of postoperative aortic regurgitation, with 98% presenting with less than mild aortic regurgitation.
Source: The Annals of Thoracic Surgery - June 24, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Early Operation for Endocarditis Complicated by Preoperative Cerebral Emboli Is Not Associated With Worsened Outcomes
Conclusions Early surgical intervention in patients with IE complicated by preoperative septic cerebral emboli does not lead to significantly worse postoperative outcomes. Early surgical intervention for IE after embolic stroke warrants consideration, particularly in patients with high-risk features such as S aureus or annular abscess, or both.
Source: The Annals of Thoracic Surgery - June 24, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Long-Term Outcomes of the Maze Procedure Combined With Mitral Valve Repair: Risk of Thromboembolism Without Anticoagulation Therapy
Conclusions Adopting appropriate selection criteria for discontinuing anticoagulation therapy, the majority of patients receiving concomitant mitral repair and the Maze procedure can discontinue warfarin with excellent long-term safety profiles.
Source: The Annals of Thoracic Surgery - June 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hemiarch and Total Arch Surgery in Patients With Previous Repair of Acute Type I Aortic Dissection
Conclusions In patients with previous acute type I aortic dissection repair, hemiarch and total arch operations have respectable morbidity and survival rates. Congestive heart failure predicts operative death, long-term mortality, and our adverse event endpoint. Cardiopulmonary bypass time predicts operative mortality, and female sex and circulatory arrest time predict long-term mortality.
Source: The Annals of Thoracic Surgery - June 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Hospital Readmissions After Continuous-Flow Left Ventricular Assist Device Implantation: Incidence, Causes, and Cost Analysis
Conclusions Gastrointestinal bleeding and CF-LVAD–related infections were the leading causes of readmission. Patients with a CF-LVAD spent 93% of their time out of hospital after implantation, and readmissions did not have a negative impact on long-term survival. New approaches to minimize these adverse events will continue to improve the efficacy and decrease the cost of CF-LVAD therapy.
Source: The Annals of Thoracic Surgery - June 19, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Early and Late Outcomes After Complete Aortic Replacement
Conclusions Complete aortic replacement can be performed with acceptable rates of morbidity and mortality. Most of these patients were younger, had associated dissection, and required multiple stages for completion. As endovascular techniques advance proximally into the ascending aorta and complete endovascular aortic repair comes closer to reality, studies like this will allow comparison.
Source: The Annals of Thoracic Surgery - June 10, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Treatment of Nonagenarians With Severe Aortic Stenosis
Conclusions Treatment of AS approximates natural life expectancy in select nonagenarians, with no significant difference in long-term survival between SAVR and TAVR. Importantly, patient quality of life improved at 1 year. With appropriate selection, nonagenarians with severe AS can benefit from treatment.
Source: The Annals of Thoracic Surgery - May 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Transapical Versus Transaortic Transcatheter Aortic Valve Implantation: A Systematic Review
Publication date: Available online 20 May 2015 Source:The Annals of Thoracic Surgery Author(s): Ben Dunne , Darren Tan , Daniel Chu , Victor Yau , Jinguo Xiao , Kwok Ming Ho , Gerald Yong , Robert Larbalestier Two alternative approaches for transcatheter aortic valve implantation (TAVI) exist for patients unsuitable for the transfemoral approach; the transapical and the transaortic approaches. It is unclear as to which approach has superior short-term outcomes. A systematic review and meta-analysis was performed to answer this question. Mortality was equivalent in the 2 groups. There was a trend toward a lower rate of s...
Source: The Annals of Thoracic Surgery - May 20, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Minimally Invasive Port Access Approach for Reoperations on the Mitral Valve
Conclusions The port access approach can be safely adopted for reoperations on the MV without compromising postoperative mortality or MV function.
Source: The Annals of Thoracic Surgery - May 12, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Does Thoracoscopic Surgery Decrease the Morbidity of Combined Lung and Chest Wall Resection?
Conclusions Thoracoscopic chest wall resection was feasible, expanded our case selection, and reduced prosthetic reconstruction. It did not, however, protect frail, elderly patients reliably. Briefer, less traumatic operations may be needed for this cohort.
Source: The Annals of Thoracic Surgery - April 24, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Evolution in the Management of Aberrant Subclavian Arteries and Related Kommerell Diverticulum
Conclusions Aberrant subclavian arteries and associated Kommerell diverticulum can be treated with acceptable rates of mortality and morbidity. The evolution toward an endovascular approach did not appear to affect late outcomes, suggesting that the choice of treatment should be based on patient-specific anatomy and associated comorbidities.
Source: The Annals of Thoracic Surgery - April 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Coronary Artery Bypass Grafting After Percutaneous Intervention Has Higher Early Mortality: A Meta-Analysis
Conclusions Patients undergoing CABG after prior percutaneous therapy have a higher incidence of myocardial infarction and mortality in the postoperative period. However, midterm survival is comparable in both cohorts.
Source: The Annals of Thoracic Surgery - April 10, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Moderate Versus Deep Hypothermic Circulatory Arrest for Elective Aortic Transverse Hemiarch Reconstruction
Conclusions MHCA with antegrade cerebral perfusion yields excellent and equivalent outcomes to DHCA for elective aortic hemiarch reconstruction. MHCA significantly improves intraoperative times and, importantly, reduces transfusion requirements compared with DHCA with a retrograde cerebral perfusion strategy.
Source: The Annals of Thoracic Surgery - March 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Atrioventricular Valve Operation in Patients With Fontan Circulation
Conclusions The AV valve operation done before, during, or after the Fontan operation is associated with low operative mortality but a high reoperation rate with significant risk of late death, transplantation, and persistent AV valve regurgitation.
Source: The Annals of Thoracic Surgery - March 30, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Comparison of 30-Day Outcomes of Transfemoral Versus Transapical Approach for Transcatheter Aortic Valve Replacement: A Single-Center US Experience
Conclusions The TA approach has similar early safety outcomes when compared with the TF approach. The TA approach is more procedurally efficient when compared with the TF approach.
Source: The Annals of Thoracic Surgery - March 6, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Propensity Adjusted Analysis of Open and Endovascular Thoracic Aortic Repair for Chronic Type B Dissection: A Twenty-Year Evaluation
Conclusions Intervention for CBAD can be performed with excellent results, either by an open or endovascular approach. The higher rate of treatment failure after TEVAR warrants modification of current device design or endovascular approach before broad application of this treatment strategy.
Source: The Annals of Thoracic Surgery - February 19, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Autologous Platelet-Rich Plasma Reduces Transfusions During Ascending Aortic Arch Repair: A Prospective, Randomized, Controlled Trial
Conclusions The use of aPRP reduced allogeneic transfusions during ascending and transverse aortic arch repair with deep hypothermic circulatory arrest. This translated to less acute renal failure, decreased length of stay, and lower transfusion costs. Further studies examining the coagulation factors of aPRP are required.
Source: The Annals of Thoracic Surgery - February 19, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Simultaneous Carotid Artery Stenting and Heart Surgery: Expanded Experience of Hybrid Surgical Procedures
Conclusions Same-day hybrid approach appeared safe in terms of early and long-term results not only for CAS and isolated CABG but also for CAS and noncoronary isolated procedures. In complex cases, the rate of stroke and myocardial infarction seemed low; in-hospital mortality, as expected, was higher. Long-term survival appeared similarly satisfactory, thus confirming the hybrid approach as a valid therapeutic option for all patients with significant internal carotid artery stenosis associated with coronary and other cardiac lesions, at least for noncomplex cases.
Source: The Annals of Thoracic Surgery - February 19, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Relationship of Single Ventricle Filling and Preload to Total Cavopulmonary Connection Hemodynamics
Conclusions Flow-independent TCPC power loss is inversely related with ventricular end-diastolic and stroke volumes. Elevated power losses may contribute to impaired diastolic filling and limited preload reserve in single ventricle patients.
Source: The Annals of Thoracic Surgery - January 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Outcomes of Open Repair for Chronic Descending Thoracic Aortic Dissection
Conclusions Open repairs of chronic descending thoracic aortic aneurysm dissections can be performed with respectable morbidity and mortality. Neurologic deficit remains low with the use of adjuncts, and early deaths are directly related to preoperative renal status. Reintervention on the involved aortic segment is low. These results allow comparisons with endovascular repair for chronic aortic dissection.
Source: The Annals of Thoracic Surgery - January 23, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement
Conclusions RDAVR by the MIS approach is associated with significantly reduced myocardial ischemic time and better valvular hemodynamic function than FS-AVR with a conventional stented bioprosthesis. Rapid deployment valves may facilitate the performance of MIS-AVR.
Source: The Annals of Thoracic Surgery - December 30, 2014 Category: Cardiovascular & Thoracic Surgery Source Type: research

Unilateral Versus Bilateral Cerebral Perfusion for Acute Type A Aortic Dissection
Conclusions As one of the largest single-center studies of the efficacy of u-ACP and b-ACP in patients with type A aortic dissection, operative mortality, stroke, temporary neurologic dysfunction, and renal failure rates were similar in both. In this intrinsically complex disease, survival is the most important outcome; u-ACP may provide cardiac surgeons with valuable technical simplicity during challenging procedures, and b-ACP may be justified for circulatory arrest times of more than 30 minutes.
Source: The Annals of Thoracic Surgery - December 30, 2014 Category: Cardiovascular & Thoracic Surgery Source Type: research

Postoperative Atrial Fibrillation After Thoracic Aortic Surgery
Conclusions Several risk factors contribute to the incidence of POAF after thoracic aortic surgery. We found that POAF significantly increased 30-day operative mortality (p < 0.0001). Our findings can be used to develop a risk stratification system for the prediction of POAF.
Source: The Annals of Thoracic Surgery - December 30, 2014 Category: Cardiovascular & Thoracic Surgery Source Type: research