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Source: The Journal of Thoracic and Cardiovascular Surgery

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Total 276 results found since Jan 2013.

Commentary: Transcending acceptable, moving toward optimal: Standardizing surgical configurations of ventricular assist device therapy
The number of patients with end-stage heart failure potentially eligible for ventricular assist device (VAD) therapy continues to increase.1 Meanwhile, VAD outcomes with current centrifugal devices have improved significantly and in the first few years after implantation are approaching those of transplantation, yet at the same time they remain encumbered by adverse events such as stroke and hemodynamic complications like aortic regurgitation (AR).2 Our understanding of the mechanisms of VAD complications has expanded from basic engineering of the devices themselves to the patient −pump interface (comorbidities, thrombog...
Source: The Journal of Thoracic and Cardiovascular Surgery - May 13, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Song Li, Daniel Zimpfer, Claudius Mahr Tags: Commentary Source Type: research

Cerebral Atherosclerosis and Early Ischemic Stroke After Left-Sided Valve Replacement Surgery
This study evaluated the impact of cerebral atherosclerosis on the risk of stroke after left-sided valve replacement surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - May 11, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Ho Jin Kim, Eun-Jae Lee, Sung-Ho Jung, Jae Won Lee, Jong S. Kim, Joon Bum Kim, Sun U. Kwon Source Type: research

Commentary: The left main controversy: Is this a real subgroup requiring custom clinical recommendations?
For 3  decades, coronary artery bypass grafting (CABG) has been the standard of care for patients with left main coronary artery stenosis (LMCAS), a practice based on trials that showed improved survival compared with medical management.1 The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) trial was the first large trial to compare percutaneous coronary intervention (PCI) with CABG in the treatment of coronary artery disease.2 The SYNTAX protocol included a prespecified exploratory analysis in the subgroup of patients with LMCAS that was underpowered for t he primary composite en...
Source: The Journal of Thoracic and Cardiovascular Surgery - May 4, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Mario Gaudino, Domenico Pagano, Nick Freemantle Tags: Commentary Source Type: research

Commentary: ART: Let it rest in peace
The Arterial Revascularization Trial (ART) was a multicenter, prospective trial consisting of 3102 patients who underwent coronary artery bypass graft (CABG) randomized to receive either bilateral internal thoracic artery (BITA) or single internal thoracic artery (SITA) grafts along with guideline-directed medical therapy (GDMT).1 Both groups received saphenous vein grafts (SVGs), and 21.8% of the SITA and 19.4% of the BITA patients also received a radial artery (RA) graft. After 10  years, there was no significant difference between the groups in mortality from any cause, or the composite endpoint of death, myocardial in...
Source: The Journal of Thoracic and Cardiovascular Surgery - April 27, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Harold L. Lazar Tags: Commentary Source Type: research

Reply: Further expansion on the horizon? Thrombectomy for stroke after cardiothoracic surgery
We read with great interest the response to our publication1 from Schweitzer and colleagues.2 They found similar rates of cerebrovascular complications in their patients after cardiac surgery: just under 3%. As with our population, computed tomography angiography was the preferred acute imaging modality. Of patients with neurological deficits 5.3% had a large vessel occlusion (LVO) stroke, compared with the 10.1% in our series. In our population, we highlighted the fact that expanded time windows opened the therapeutic opportunity of thrombectomy for LVO to patients waking from anesthesia with deficit.
Source: The Journal of Thoracic and Cardiovascular Surgery - April 16, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Faheem Sheriff, Kenneth Shelton, Arminder S. Jassar, Aman B. Patel, Thabele M. Leslie-Mazwi Tags: Letter to the Editor Source Type: research

Reply to author: Further expansion on the horizon? Thrombectomy for stroke after cardiothoracic surgery
We read with great interest the response to our publication1 from Schweitzer and colleagues.2 They found similar rates of cerebrovascular complications in their patients after cardiac surgery: just under 3%. As with our population, computed tomography angiography was the preferred acute imaging modality. Of patients with neurological deficits 5.3% had a large vessel occlusion (LVO) stroke, compared with the 10.1% in our series. In our population, we highlighted the fact that expanded time windows opened the therapeutic opportunity of thrombectomy for LVO to patients waking from anesthesia with deficit.
Source: The Journal of Thoracic and Cardiovascular Surgery - April 16, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Faheem Sheriff, Kenneth Shelton, Arminder S. Jassar, Aman B. Patel, Thabele M. Leslie-Mazwi Tags: Adult: Perioperative Management: Letters to the Editor Source Type: research

Commentary: Aortic arch surgery —Acting your age
Growing technology and access to health care have led to improved life spans across the world. It is projected that life expectancy may increase over the coming decades from 79.7  years in 2017 to 85.6 years by 2060 in the United States.1 With resultant changes in demographics, the need for complex surgical procedures such as aortic surgery in the elderly population is now commonplace. Despite technical advances and improved outcomes in proximal aortic surgery, the complex ity of these operations still predispose the elderly to higher risks of stroke, delirium, and renal failure.
Source: The Journal of Thoracic and Cardiovascular Surgery - March 11, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Kanika Kalra, Edward P. Chen Tags: Commentary Source Type: research

Commentary: Postpericardial syndrome after cardiac surgery: Is it really benign?
Lehto and colleagues1 report on the long-term outcomes of postpericardiotomy syndrome (PPS) occurring after aortic valve replacement (AVR) surgery. The patient cohort was drawn from 2 large Finnish multi-institutional clinical trial databases, namely CAREAVR (Consortium of Studies in the Field of Atrial Fibrillation, Stroke, and Bleeding in Patients Undergoing Aortic Valve Replacement) and CAREBANK (Cardiovascular Research Consortium---A Prospective Project to Identify Biomarkers of Morbidity and Mortality in Cardiovascular Interventional Patients),1 in which a total of 671 AVR patients (bioprosthesis, n  = 361 and mecha...
Source: The Journal of Thoracic and Cardiovascular Surgery - March 11, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Suk Jung Choo Tags: Commentary Source Type: research

Commentary: Subclinical valve thrombosis —Are all transcatheter aortic valves created equal?
Transcatheter aortic valve insertion (TAVI) technology presents new opportunities but also new challenges, including subclinical valve thrombosis (SCVT). In this edition of the Journal, Woldendorp and colleagues1 report a meta-analysis investigating SCVT after TAVI focusing on prevalence, predisposing factors, management, and consequences. Twelve studies that screened for SCVT using multidetector computed tomography (MDCT) were included comparing stroke risk between patients with SCVT and those without, as well as the effects of antiplatelet therapy and oral anticoagulation (OAC) on preventing SCVT.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 20, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Sajiram Sarvananthan, Clifford William Barlow Tags: Commentary Source Type: research

Commentary: If the news is good, it  is better that we know … if the news is bad, it is better than we know fast
The risk of stroke in aortic arch (AA) surgery remains a serious concern, despite modern surgical techniques and strategies for cerebral protection. Brain perfusion during AA surgery faces embolic and global ischemic threats, from manipulation and crossclamping of the aorta to malperfusion due to incomplete protective perfusion during the circulatory arrest phase of the operation. Intraoperative diagnosis of stroke can be a challenge, and there are no current standard guidelines for intraoperative neuromonitoring (IONM).
Source: The Journal of Thoracic and Cardiovascular Surgery - February 20, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Lisa Q. Rong, Luca P. Weltert, Mario F.L. Gaudino Tags: Commentary Source Type: research

Subclinical valve thrombosis in transcatheter aortic valve implantation: A systematic review and meta-analysis.
Recent high-resolution CT studies after transcatheter aortic valve insertion (TAVI) have reported high prevalence of subclinical valve thrombosis (SCVT), potentially contributing to increased risk of late stroke. We aimed to investigate SCVT after TAVI patients with focus on prevalence, predisposing factors, management, and potential sequelae.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 18, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Kei Woldendorp, Mathew P. Doyle, Deborah Black, Martin Ng, Anthony Keech, Stuart Grieve, Paul G. Bannon Source Type: research

Utility of neuromonitoring in hypothermic circulatory arrest cases for early detection of stroke: Listening through the noise
Stroke remains a potentially devastating complication of aortic arch intervention. The value of neurophysiologic intraoperative monitoring (NIOM) in the early identification of stroke is unclear. We evaluated the utility of NIOM for early stroke detection in aortic arch surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 17, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Christian V. Ghincea, Devon A. Anderson, Yuki Ikeno, Gavriel F. Roda, Mohamed Eldeiry, Michael R. Bronsert, Kelly Aunkst, David A. Fullerton, T. Brett Reece, Muhammad Aftab Tags: Adult Source Type: research

Utility of Neuromonitoring in Hypothermic Circulatory Arrest Cases for Early Detection of Stroke – Listening through the Noise
– Stroke remains a potentially devastating complication of aortic arch intervention. The value of neurophysiologic intraoperative monitoring (NIOM) in the early identification of stroke is unclear. We evaluated the utility of NIOM for early stroke detection in aortic arch surgery.
Source: The Journal of Thoracic and Cardiovascular Surgery - February 17, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Christian V. Ghincea, Devon A. Anderson, Yuki Ikeno, Gavriel F. Roda, Mohamed Eldeiry, Michael R. Bronsert, Kelly Aunkst, David A. Fullerton, T. Brett Reece, Muhammad Aftab Source Type: research

Reply: Time to show greater appreciation of large vessel occlusion stroke after cardiovascular surgery
We read with great interest the letter by Schweizer and colleagues.1 It seems timely that efforts to increase awareness of the issues relating to the importance of treating large vessel occlusion (LVO) in the setting of cardiovascular surgery (CVS) is being brought to the forefront. LVO stroke is relatively rare; Sheriff and colleagues2 reported an overall stroke rate of 2.48% in their series, of which ischemic stroke accounted for 92.5% and LVO stroke comprised only 10.1%. Similarly, Schweizer and colleagues reported an overall stroke rate of 2.9%, of which LVO stroke accounted for only 5.3%, or 3 of 57 patients.
Source: The Journal of Thoracic and Cardiovascular Surgery - January 12, 2020 Category: Cardiovascular & Thoracic Surgery Authors: Suk Jung Choo Tags: Letter to the Editor Source Type: research

Reply from the authors: The optimum arterial cannulation site during open aortic arch repair: Is it the axillary artery?
Thank you for thoughtful comments. I agree with your comment that the possibility of bias exists from combined axillary artery (AA) cannulation. We carried out an analysis comparison outcome of pure AA and non-AA groups. Pure AA (n  = 177) and non-AA (n = 159) groups were reviewed. Results revealed that the AA group showed a lower rate in early stroke (2.8% vs 8.2%, P = .03), as well as lower trends in hospital (5.5% vs 10.1%, P = .09) and 30-day mortality rate (4.5% vs 9.4%, P = .08). In matching data (pairs = 87) , the AA group also showed a lower rate in early stroke (2.3% vs 8.2%, P = .04).
Source: The Journal of Thoracic and Cardiovascular Surgery - December 15, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Jung-Hwan Kim, Seung Hyun Lee, Sak Lee, Young-Nam Youn, Kyung-Jong Yoo, Hyun-Chel Joo Tags: Adult: Aorta: Letter to the Editor Source Type: research