共查询到20条相似文献，搜索用时 31 毫秒
1.
Daisuke Yoshioka Hiroo Takayama Arthur R. Garan Veli K. Topkara Jiho Han Boyganzi Li Paul Kurlansky Melana Yuzefpolskaya Paolo C. Colombo Yoshifumi Naka Koji Takeda 《The Journal of thoracic and cardiovascular surgery》2017,153(4):752-762.e5
Objective
The role of short-term mechanical circulatory support has increased in patients with refractory cardiogenic shock. However, limited data exist on the outcomes of a bridge to a durable left ventricular assist device strategy using short-term mechanical circulatory support.Methods
We retrospectively reviewed 382 patients who underwent continuous-flow left ventricular assist device insertion between 2004 and 2014. Of these, 45 (12%) were bridged with short-term mechanical circulatory support devices for refractory cardiogenic shock. We analyzed early and midterm outcomes in this bridged cohort. Multivariate Cox proportional hazards modeling was performed to evaluate the predictor of overall death in the entire cohort.Results
The mean age of the bridged cohort was 53 ± 10 years, and 87% were male. The types of initial support included percutaneous devices in 24 patients (53%) and external continuous-flow ventricular assist device in 21 patients (47%). The median duration of short-term mechanical circulatory support was 14.0 (interquartile range, 7.5-29.5) days. The short-term mechanical circulatory support significantly improved end-organ function and hemodynamics. After conversion to durable left ventricular assist device insertion, in-hospital mortality was 18%. The incidence of right ventricular assist device use was high at 27%. The overall survival was 70% and 62% at 1 and 2 years, respectively. Cox multivariate hazard analysis in the entire cohort demonstrated that the use of a postoperative right ventricular assist device was a significant predictor of overall death (hazard ratio, 4.04; P < .001; 95% confidence interval, 1.97-7.94), but the use of a short-term mechanical circulatory support was not (P = .937).Conclusions
Short-term mechanical circulatory support can optimize patients in refractory cardiogenic shock and serve as a bridge to implantation of a durable left ventricular assist device. However, the early mortality rate after durable left ventricular assist device implantation is high because of unrecognized right ventricular failure. 相似文献2.
Fernando Luiz Zanoni Rafael Simas Raphael Grillo da Silva Ana Cristina Breithaupt-Faloppa Raphael dos Santos Coutinho e Silva Fábio Biscegli Jatene Luiz Felipe P. Moreira 《The Journal of thoracic and cardiovascular surgery》2017,153(4):855-863.e1
Objectives
To evaluate the influence of bilateral or left sympathectomy on left ventricular remodeling and function after myocardial infarction in rats.Methods
Myocardial infarction was induced in rats by ligation of the left anterior descending coronary. Seven days later, rats were divided into 4 groups: the myocardial infarction, myocardial infarction with left sympathectomy, myocardial infarction with bilateral sympathectomy, and sham groups. After 8 weeks, left ventricular function was evaluated with the use of a pressure-volume conductance catheter under steady-state conditions and pharmacological stress. Infarct size and extracellular matrix fibrosis were evaluated, and cardiac matrix metalloproteinases and myocardial inflammatory markers were analyzed.Results
The myocardial infarction and left sympathectomy group had an increased end diastolic volume, whereas the bilateral sympathectomy group had a mean end-diastolic volume similar to that of the sham group (P < .002). Significant reduction in ejection fraction was observed in the myocardial infarction and left sympathectomy group, whereas it was preserved after bilateral sympathectomy (P < .001). In response to dobutamine, left ventricular contractility increased in sham rats, rising stroke work, cardiac output, systolic volume, end-diastolic volume, ejection fraction, and dP/dt max. Only bilateral sympathectomy rats had significant increases in ejection fraction (P < .001) with dobutamine. Fibrotic tissue and matrix metalloproteinase expression decreased in the bilateral sympathectomy group compared to that in the myocardial infarction group (P < .001) and was associated with left ventricular wall thickness maintenance and better apoptotic markers in noninfarcted myocardium.Conclusions
Bilateral sympathectomy effectively attenuated left ventricular remodeling and preserved systolic function after myocardial infarction induction in rats. 相似文献3.
Sven-Erik Bartfay Göran Dellgren Hans Lidén Mikael Holmberg Jakob Gäbel Bengt Redfors Odd Bech-Hanssen Kristjan Karason 《The Journal of thoracic and cardiovascular surgery》2017,153(2):360-367.e1
Objective
Right ventricular failure in patients treated using left ventricular assist devices is associated with poor outcomes. We assessed the strategy of preplanned biventricular assist device implantation in patients with a high risk for right ventricular failure.Methods
Between 2010 and 2014, we assigned 20 patients to preplanned biventricular assist device and 21 patients to left ventricular assist device as a bridge to heart transplantation on the basis of the estimated risk of postimplant right ventricular failure. Preimplant characteristics and postimplant outcomes were compared between the 2 groups.Results
Patients with a biventricular assist device were younger, more often female, and more frequently had nonischemic heart disease than left ventricular assist device recipients. At preoperative assessment, biventricular assist device recipients had poorer Interagency Registry for Mechanically Assisted Circulatory Support profiles, a lower cardiac index, and more compromised right ventricular function. Survival on device to heart transplantation/weaning/destination for biventricular assist device and left ventricular assist device recipients was 90% versus 86% (not significant), with shorter heart transplantation waiting times for biventricular assist device recipients (median days, 154 vs 302, P < .001). Overall survival at 1 year was 85% (95% confidence interval, 62-95) versus 86% (95% confidence interval, 64-95) (not significant). The majority of both biventricular assist device and left ventricular assist device recipients could be discharged to home during the heart transplantation waiting time (55% vs 71%, not significant), and complication rates on device were comparable between groups (major stroke 10% vs 10%, not significant).Conclusions
Planned in advance, the biventricular assist device seems to be a feasible option as bridge to heart transplantation for patients with a high risk of postimplant right ventricular failure. The outcomes for these patients were similar to those observed for contemporary left ventricular assist device recipients, despite those receiving biventricular assist devices being more severely ill. 相似文献4.
Jan L. Bruse Abbas Khushnood Kristin McLeod Giovanni Biglino Maxime Sermesant Xavier Pennec Andrew M. Taylor Tain-Yen Hsia Silvia Schievano 《The Journal of thoracic and cardiovascular surgery》2017,153(2):418-427
Objectives
Even after successful aortic coarctation repair, there remains a significant incidence of late systemic hypertension and other morbidities. Independently of residual obstruction, aortic arch morphology alone may affect cardiac function and outcome. We sought to uncover the relationship of arch 3-dimensional shape features with functional data obtained from cardiac magnetic resonance scans.Methods
Three-dimensional aortic arch shape models of 53 patients (mean age, 22.3 ± 5.6 years) 12 to 38 years after aortic coarctation repair were reconstructed from cardiac magnetic resonance data. A novel validated statistical shape analysis method computed a 3-dimensional mean anatomic shape of all aortic arches and calculated deformation vectors of the mean shape toward each patient's arch anatomy. From these deformations, 3-dimensional shape features most related to left ventricular ejection fraction, indexed left ventricular end-diastolic volume, indexed left ventricular mass, and resting systolic blood pressure were extracted from the deformation vectors via partial least-squares regression.Results
Distinct arch shape features correlated significantly with left ventricular ejection fraction (r = 0.42, P = .024), indexed left ventricular end-diastolic volume (r = 0.65, P < .001), and indexed left ventricular mass (r = 0.44, P = .014). Lower left ventricular ejection fraction, larger indexed left ventricular end-diastolic volume, and increased indexed left ventricular mass were identified with an aortic arch shape that has an elongated ascending aorta with a high arch height-to-width ratio, a relatively short proximal transverse arch, and a relatively dilated descending aorta. High blood pressure seemed to be linked to gothic arch shape features, but this did not achieve statistical significance.Conclusions
Independently of hemodynamically important arch obstruction or residual aortic coarctation, specific aortic arch shape features late after successful aortic coarctation repair seem to be associated with worse left ventricular function. Analyzing 3-dimensional shape information via statistical shape modeling can be an adjunct to long-term risk assessment in patients after aortic coarctation repair. 相似文献5.
Hui Zhang Pei Cheng Ge Jin Ding Han Yi Luo Jia Li 《The Journal of thoracic and cardiovascular surgery》2017,153(3):648-653
Objective
Few data are available regarding the surgical strategies for an anomalous origin of the left coronary artery (LCA) from the right pulmonary artery (RPA) with an intramural aortic course. We reviewed our experience in a case series of 10 children.Methods
From 2007 to 2014, 10 patients (7 boys and 3 girls, aged 3 months to 11 years, median 21 months) underwent surgical repair. Before the operation, echocardiography showed the mean left ventricular ejection fraction 45% ± 10% and mean fractional shortening fraction 21% ± 7%. Moderate to severe mitral regurgitation was found in 4 patients and left ventricular aneurysm in 5 patients. The intramural aortic course of LCA was not diagnosed preoperatively in any of the patients.Results
During the operation, the LCA orifice was seen and 2 types were identified: at the bifurcation of the main pulmonary artery and RPA in 3 patients, and more distal along the RPA from the bifurcation in 7 patients. In the first type, direct coronary button transfer was performed. In the second type, button transfer with unroofing of the intramural course was performed. Annuloplasty of the mitral valve was performed in 4 patients and the aneurysm was repaired with plication technique in 2 patients. Postoperatively, 2 patients died of cardiac failure. Others showed significantly improved left ventricular function at follow-up as compared with preoperative measures (mean ejection fraction 67% ± 6%, mean fractional shortening 32% ± 3%, P = .01 for both).Conclusions
Careful attention should be paid to the extremely rare association of an aortic intramural course before and during an operation when dealing with anomalous LCA from the RPA. Surgical strategies for aortic reimplantation include coronary button transfer and unroofing of the intramural segment. The outcomes are encouraging. 相似文献6.
Luca A. Vricella William A. Ravekes Eloisa Arbustini Robert D.B. Jaquiss Constantine Mavroudis Harry C. Dietz Marshall L. Jacobs Narutoshi Hibino Duke E. Cameron 《The Journal of thoracic and cardiovascular surgery》2017,153(2):399-403
Background
In pediatric patients with connective tissue disorders (CTDs), early cardiac presentation often involves severe mitral regurgitation (MR) associated with severe bileaflet prolapse and, less frequently, aortic root enlargement. We adopted a simplified repair to address MR and prevent systolic anterior motion (SAM) in this unique group of patients.Materials and Methods
Retrospective review of clinical and echocardiographic data of all pediatric patients (age < 18 years) with CTD and MR undergoing simplified repair at 3 institutions (2000-2014).Results
Eighteen children who underwent surgery for severe MR and bileaflet prolapse were identified. All were treated with ring annuloplasty and Alfieri edge-to-edge repair. Median age and weight were 8.2 years (range, 0.4-17.2 years) and 24.9 kg (5.6-63.3 kg), respectively. Median left ventricular end diastolic dimension median z score was 4.9 (2.1-11.9). One patient died (5.6%), and there were no other major complications. Among survivors, 94.4% had mild regurgitation or less, with no stenosis or SAM at median clinical follow-up of 2.4 years (range, 0-13.9 years). Median left ventricular end-diastolic dimension z score regressed to 1.3 (?0.5 to 4.3).Conclusions
In pediatric patients with CTD and severe MR, a simplified approach is associated with intermediate-term competence, absence of SAM or significant stenosis, and regression of left ventricular enlargement. 相似文献7.
Paul C. Tang Jonathan W. Haft Matthew A. Romano Abbas Bitar Reema Hasan Maryse Palardy Xiaoting Wu Keith Aaronson Francis D. Pagani 《The Journal of thoracic and cardiovascular surgery》2019,157(5):1851-1860.e1
Objective
To investigate whether preoperative echocardiography findings determine postoperative continuous-flow left ventricular assist device outcomes.Methods
From January 2003 to June 2017, 490 patients received a durable, continuous-flow left ventricular assist device. Two-step clustering of parameters including heart rate and preoperative echocardiographic findings (ie, left ventricular [LV] ejection fraction, right ventricular [RV] function, aortic insufficiency, mitral regurgitation [MR], tricuspid regurgitation [TR]) was performed and identified 5 distinct clusters associated with LV failure: group 1: moderate right ventricular dysfunction (RVD), severe MR and mild TR (n = 110); group 2: severe RVD, severe MR and TR (n = 64); group 3: moderate RVD and severe aortic insufficiency (n = 16); group 4: mild RVD and mild valvular pathology (n = 163); and group 5: moderate-severe RVD and mild valvular pathology (n = 137). Silhouette measure of cohesion and separation demonstrated satisfactory separation at 0.6.Results
Group 2 had the greatest Interagency Registry for Mechanically Assisted Circulatory Support Level 1 (25%, P = .010), preoperative right atrial pressure (11 ± 5 mm Hg, P < .001), incidence of postoperative right ventricular failure (RVF; 20%, P = .001), delayed closure of the sternum (61%, P = .002), postoperative permanent dialysis (6%, P = .04), rate of tricuspid valve repair (n = 52; 81%, P < .001), and lowest RV stroke work index (489 ± 228 cc mm Hg/m2/beat, P < .001). RVF in groups 1, 3, 4, and 5 was 6%, 0%, 4%, and 9%, respectively. No differences in incidence of heart transplantation (P = .400) or survival (P = .535) were found. Severe TR predicted RVF in those with moderate-severe preoperative RVD (P = .001, odds ratio 3.9).Conclusions
Clustering demonstrated the importance of preoperative TR in predicting RVF. Combined severe LV and RV failure with severe MR and TR portends the worse prognosis. 相似文献8.
Gianluigi Perri Sergio Filippelli Rachele Adorisio Roberta Iacobelli Francesca Iodice Giuseppina Testa Maria Giovanna Paglietti Domenico D&#x;Amario Massimo Massetti Antonio Amodeo 《The Journal of thoracic and cardiovascular surgery》2017,153(3):669-674
Objective
We report our experience with the use of a left ventricular assist device (LVAD) as destination therapy (DT) for the management of patients with cardiac end-stage dystrophinopathies.Methods
From February 2011 to February 2016, 7 patients with dystrophinopathies and dilated cardiomyopathy (DCM) were treated with LVADs at our institution. Median age at surgery was 16.5 years (range, 14.2-23.4 years). All patients were preoperatively evaluated by a multidisciplinary team approach.Results
All patients survived to hospital discharge. The early postoperative course was characterized by abdominal bleeding (1 patient) and retropharyngeal bleeding (1 patient). Because of abdominal or retropharyngeal bleeding, both required postoperative heparin infusion discontinuation for 35 and 33 days, respectively. Among the late complications, 1 child developed osteolysis and infection at the pedestal site of the device, which required surgical displacement; 1 patient required gastrostomy as a result of poor feeding, and another had a cerebral stroke, which was treated with percutaneous thrombus aspiration. The other 2 patients did not show early or late complications. At a median follow-up time of 21.7 months (range, 3-45 months) there have been 3 deaths: 1 patient died of a lung infection after 45 months, 1 died of tracheal bleeding after 29 months, and 1 died of cerebral hemorrhage after 14 months.Conclusions
Our experience indicates that the use of an LVAD as DT in patients with dystrophinopathies with end-stage DCM is feasible, suggesting that it may be suitable as a palliative therapy for the treatment of these patients with no other therapeutic options. 相似文献9.
Cheng Zhou Dongfang Wang Cherry Ballard-Croft Guangfeng Zhao Hassan K. Reda Stephen Topaz Joseph Zwischenberger 《The Journal of thoracic and cardiovascular surgery》2017,153(1):175-182
Objective
We are developing a transapical-to-aorta double lumen cannula (TAA DLC) for a less-invasive/more dependable neonatal left ventricular assist device.Methods
The 18-Fr TAA DLC prototypes were bench tested and evaluated for 6 hours in neonate lambs (n = 6, 7.7-10 kg). The cardiac apex was exposed through a left anterolateral thoracotomy through the sixth intercostal space. The TAA DLC was inserted through a mattress stitch on apex, passing LV-aortic valve, into the ascending aorta with insertion/deployment guided by pressure waveform. The DLC was connected to blood pump. Cardiac output and aortic root blood flow were measured with perivascular flow sensors. Activated clotting time was maintained at 180-250 seconds.Results
The DLC pumped up to 1.8 L/min flow against 63 mm Hg drainage pressure and 145 mm Hg infusion pressure in bench testing. In all lambs, the DLC was inserted/deployed properly within 1 minute on the first attempt. Pumping flow was maintained at 1.2-1.3 L/min. Systolic arterial pressure decreased and diastolic arterial pressure/mean arterial pressure increased, indicating decreased afterload and increased perfusion pressure. Left ventricular end-diastolic pressure decreased from 13 ± 1 mm Hg to 6 ± 2 mm Hg, indicating decreased preload. Aortic root backward flow was 2.4% ± 0.6% without DLC and 3.5% ± 0.8% of cardiac output with DLC, indicating no significant DLC-induced aortic valve regurgitation. After 6 hours, free hemoglobin was <5 mg/dL with hemoglobin/platelets unchanged. No significant thrombus was found in pumps/DLCs. No trauma was found in LV, aortic valve, and aorta.Conclusions
Our TAA DLC-based neonate left ventricular assist device efficiently unloaded the LV in lambs. 相似文献10.
Travis J. Wilder Brian W. McCrindle Edward J. Hickey Gerhard Ziemer Christo I. Tchervenkov Marshall L. Jacobs Peter J. Gruber Eugene H. Blackstone William G. Williams William M. DeCampli Christopher A. Caldarone Christian Pizarro 《The Journal of thoracic and cardiovascular surgery》2017,153(1):163-172.e6
Background
For neonates with critical left ventricular outflow tract obstruction (LVOTO), hybrid procedures are an alternative to the Norwood stage 1 procedure. Despite perceived advantages, however, outcomes are not well defined. Therefore, we compared outcomes after stage 1 hybrid and Norwood procedures.Methods
In a critical LVOTO inception cohort (2005-2014; 20 institutions), a total of 564 neonates underwent stage 1 palliation with the Norwood operation with a modified Blalock-Taussig shunt (NW-BT; n = 232; 41%), Norwood operation with a right ventricle–to–pulmonary artery conduit (NW-RVPA; n = 222; 39%), or a hybrid procedure (n = 110; 20%). Post–stage 1 outcomes were analyzed via competing-risks and parametric hazard analyses and compared among all 564 patients and between patients who underwent propensity-matched hybrid and those who underwent NW-BT/NW-RVPA.Results
By 6 years after the stage 1 operation, 50% ± 3%, 7% ± 2%, and 4% ± 1% of patients transitioned to Fontan, transplantation, and biventricular repair, respectively, whereas 7% ± 2% were alive without transition and 32% ± 2% died. Risk factors for death without transition included procedure type, smaller ascending aorta, aortic valve atresia, and lower birth weight. Risk-adjusted 4-year survival was better after NW-RVPA than after NW-BT or hybrid (76% vs 60% vs 61%; P < .001). Furthermore, for neonates with lower birth weight (<～2 kg), an interaction between birth weight and hybrid resulted in a trend toward better survival after hybrid compared with NW-BT or NW-RVPA. For propensity-matched neonates between hybrid and NW-BT (88 pairs), 4-year survival was similar (62% vs 57%; P = .58). For propensity-matched neonates between hybrid and NW-RVPA (81 pairs), 4-year survival was better after NW-RVPA (59% vs 75%; P = .008).Conclusions
For neonates with critical LVOTO undergoing single-ventricle palliation, NW-RVPA was associated with the best overall survival. Hybrid strategies are not a lower-risk alternative to Norwood operations overall; however, the impact of lower birth weight on survival may be mitigated after hybrid procedures compared with Norwood operations. 相似文献11.
Victor X. Mosquera Alberto Bouzas-Mosquera Miguel González-Barbeito Victor Bautista-Hernandez Javier Muñiz Nemesio Alvarez-García José J. Cuenca-Castillo 《The Journal of thoracic and cardiovascular surgery》2017,153(6):1275-1284.e7
Objectives
The enlargement of the left atrium has been identified as a marker of chronically increased left ventricular filling pressure and left ventricular diastolic dysfunction. This study aims to evaluate the association of indexed left atrial diameter with stroke, cardiovascular mortality, the combined event, and all-cause mortality in patients who underwent aortic valve surgery.Methods
Indexed left atrial diameter was measured in 2011 adult patients (mean age, 70.9 ± 10.8 years; 58.7% were men) who underwent aortic valve surgery between January 2008 and March 2016.Results
On the basis of the criteria of the American Society of Echocardiography, indexed left atrial diameter was normal in 64% of patients, mildly enlarged in 12.4% of patients, moderately enlarged in 9.2% of patients, and severely enlarged in 14.3% of patients. Over a mean follow-up period of 3.2 ± 2.1 years, there were 334 deaths and 97 strokes. Cardiovascular mortality survival at 5 years among patients with normal, mild, moderate, and severe left atrial enlargement was 91.6%, 86.8%, 77.9%, and 77.4%, respectively (P < .001). After covariable adjustment, Cox regression analysis showed indexed left atrial diameter as an independent predictor of all-cause mortality (hazard ratio per 1-cm/m2 increment, 1.545; 95% confidence interval, 1.252-1.906, P < .001), cardiovascular death (hazard ratio per 1-cm/m2 increment, 1.971; 95% confidence interval, 1.541-2.520; P < .001), and the combined event (hazard ratio per 1-cm/m2 increment, 1.673; 95% confidence interval, 1.321-2.119; P < .001).Conclusions
Indexed left atrial diameter is a strong predictor of long-term outcomes in patients with aortic valve diseases who undergo surgery. 相似文献12.
Umberto Benedetto Massimo Caputo Mario Gaudino Roberto Marsico Cha Rajakaruna Alan Bryan Gianni D. Angelini 《The Journal of thoracic and cardiovascular surgery》2017,153(1):79-88.e4
Objectives
We conducted propensity score matching to determine whether the use of the right internal thoracic artery (RITA) confers a survival advantage when compared with the radial artery (RA) as second arterial conduit in coronary artery bypass grafting.Methods
The study population included a highly selected low-risk group of patients who received the RITA (n = 764) or the RA (n = 1990) as second arterial conduit. We obtained 764 matched pairs that were comparable for all pretreatment variables. A time-segmented Cox regression model that stratified on the matched pairs was used to investigate the effect of treatment on late mortality.Results
After a mean follow-up of 10.2 ± 4.5 years (maximum 17.3 years), survival probabilities at 5, 10, and 15 years were 96.4% ± 0.7% versus 95.4% ± 0.7%, 91.0% ± 1.1% versus 89.1% ± 1.2%, and 82.4% ± 1.9% versus 77.2% ± 2.5% in the RITA and RA groups, respectively. During the first 4 years, RITA and RA were comparable in terms of mortality (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.56-1.78; P = .98). However, after 4 years RITA was associated with a significant reduction in late mortality (HR, 0.67; 95% CI, 0.48-0.95; P = .02). RITA was superior to RA when the experimental conduit was used to graft the left coronary system (HR, 0.69; 95% CI, 0.47-0.99; P = .04) but not the right coronary system (HR, 0.98; 95% CI, 0.59-1.62; P = .93).Conclusions
In a highly selected low-risk group of patients, the use of the RITA as second arterial conduit instead of the RA was associated with better survival when used to graft the left but not the right coronary artery. 相似文献13.
Antonella Galeone Shaida Varnous Guillaume Lebreton Eleodoro Barreda Sara Hariri Alain Pavie Pascal Leprince 《The Journal of thoracic and cardiovascular surgery》2017,153(3):622-630
Objective
To evaluate the influence of cardiac arrest?resuscitated donors (CARDs) on the outcome of heart recipients.Methods
Patients transplanted between July 2004 and December 2012 were divided into 2 groups according to the history of cardiac arrest in donors and their clinical records were retrospectively reviewed.Results
A total of 584 heart transplantations were performed during the study period, and 117 recipients received an organ from a CARD. There were no differences between the 2 groups with regards to recipient age, sex, cardiomyopathy, preoperative extracorporeal membrane oxygenation, national high emergency waiting list, and redo surgery. Donors who sustained a cardiac arrest were significantly younger (44 [32-51] vs 49 [41-56] years; P < .001), their main cause of death was anoxia (57% vs 1%; P < .001), and they had significantly greater troponin T peak levels (0.51 [0.128-3.108] vs 0.11 [0.04-0.43] ng/mL; P < .001). Median cardiac arrest duration was 15 minutes (5-25). No difference was noted in donors with regards to left ventricular ejection fraction at time of organ procurement (62% ± 8% vs 63% ± 8%; P = .2). There were no differences between the 2 groups with regards to ischemic time (179 ± 60 vs 183 ± 59 minutes; P = .43), need for postoperative extracorporeal membrane oxygenation for primary graft failure (31% vs 30%; P = .993) and 30-days mortality. Recipients receiving an organ from a CARD had a significantly better 10 year survival (69.4% vs 50.4%; P = .017).Conclusions
History of cardiac arrest in donors with a preserved left ventricular ejection fraction at time of organ procurement doesn't affect outcome of heart recipients. 相似文献14.
Joshua L. Hermsen Thomas M. Burke Stephen P. Seslar David S. Owens Beth A. Ripley Nahush A. Mokadam Edward D. Verrier 《The Journal of thoracic and cardiovascular surgery》2017,153(1):132-140
Objective
Static 3-dimensional printing is used for operative planning in cases that involve difficult anatomy. An interactive 3D print allowing deliberate surgical practice would represent an advance.Methods
Two patients with hypertrophic cardiomyopathy had 3-dimensional prints constructed preoperatively. Stereolithography files were generated by segmentation of chest computed tomographic scans. Prints were made with hydrogel material, yielding tissue-like models that can be surgically manipulated. Septal myectomy of the print was performed preoperatively in the simulation laboratory. Volumetric measures of print and patient resected specimens were compared. An assessment tool was developed and used to rate the utility of this process. Clinical and echocardiographic data were reviewed.Results
There was congruence between volumes of print and patient resection specimens (patient 1, 3.5 cm3 and 3.0 cm3, respectively; patient 2, 4.0 cm3 and 4.0 cm3, respectively). The prints were rated useful (3.5 and 3.6 on a 5-point Likert scale) for preoperative visualization, planning, and practice. Intraoperative echocardiographic assessment showed adequate relief of left ventricular outflow tract obstruction (patient 1, 80 mm Hg to 18 mm Hg; patient 2, 96 mm Hg to 9 mm Hg). Both patients reported symptomatic improvement (New York Heart Association functional class III to class I).Conclusions
Three-dimensional printing of interactive hypertrophic cardiomyopathy heart models allows for patient-specific preoperative simulation. Resection volume relationships were congruous on both specimens and suggest evidence of construct validity. This model also holds educational promise for simulation of a low-volume, high-risk operation that is traditionally difficult to teach. 相似文献15.
Nicholas D. Andersen James M. Meza Matthew R. Byler Andrew J. Lodge Kevin D. Hill Christoph P. Hornik Robert D.B. Jaquiss 《The Journal of thoracic and cardiovascular surgery》2017,153(6):1490-1500.e1
Objective
Placement of a right ventricle–pulmonary artery shunt to the left or right of the neoaorta may influence reinterventions, pulmonary artery development, and survival after the Norwood procedure because of differences in shunt and pulmonary artery geometry and blood flow.Methods
We analyzed the Pediatric Heart Network Single Ventricle Reconstruction Trial public use dataset. Comparisons were made between patients who received a left- or right-sided right ventricle–pulmonary artery shunt during the Norwood procedure in both the overall (n = 274) and the propensity score–matched (67 pairs) patient cohorts.Results
A left-sided shunt was placed in 168 patients (61%), and a right-sided shunt was placed in 106 patients (39%). At the 12-month follow-up, there were no differences in pulmonary artery measurements, hemodynamic measurements, or pulmonary artery reinterventions between shunt groups. However, the right-sided shunt was associated with fewer surgical shunt revisions in both the overall (8.3 vs 1.9 events per 100 infants, P = .05) and the propensity score–matched (17.9 vs 0 events per 100 infants, P < .001) patient cohorts. In the propensity score–matched cohort only, right-sided shunts were further associated with fewer serious adverse events (84 vs 46 events per 100 infants, P = .01) and improved transplantation-free survival at 3 years follow-up (61% [95% confidence interval, 48-72] vs 80% [95% confidence interval, 69-88], P = .04).Conclusions
In the Single Ventricle Reconstruction trial, right ventricle–pulmonary artery shunt placement to the right of the neoaorta was associated with fewer shunt revisions and may contribute to improved outcomes in select patients. 相似文献16.
H.-K. Wang Y.-C. Lai Y.-H. Lin H.-J. Chiou Y.-H. Chou 《Transplantation proceedings》2017,49(5):1073-1075
Background
Liver stiffness is associated with the degree of fibrosis along with other factors. Abrupt change of liver perfusion after hepatectomy is one such factor. In this study, we performed ultrasound elastography to explore the stiffness of the right lobe liver before and after hepatectomy in donors who underwent resection of left lobe or lateral segment of liver.Methods
A total of 32 left lobe liver donors (18 male and 14 female; age range, 21–55 years; mean age, 35.1 years; 19 left lobectomy with middle hepatic reserved for graft and 13 lateral segmentectomy with middle hepatic vein reserved in the remnant liver) were included in this study. Liver stiffness was measured by means of ultrasound elastography with the use of acoustic radiation force impulse imaging. Stiffness of the right lobe liver was obtained by means of right intercostal approach.Results
The stiffness of remnant right lobe liver significantly increased after hepatectomy (1.24 ± 0.18 vs 1.10 ± 0.13 m/s; P = .001). Donors of left lobe liver showed higher stiffness in the remnant right lobe liver compared with donors of lateral segment (1.30 ± 0.18 vs 1.15 ± 0.14 m/s; P = .027). There was no significant correlation between the remnant right lobe liver stiffness, postoperative liver function, and flow parameters of hepatic artery and portal vein.Conclusions
The stiffness of remnant liver significantly increased after hepatectomy. Furthermore, the stiffness was higher in donors undergoing left lobectomy compared with those undergoing lateral segmentectomy. 相似文献17.
Francesco Nappi Cristiano Spadaccio Antonio Nenna Mario Lusini Massimiliano Fraldi Christophe Acar Massimo Chello 《The Journal of thoracic and cardiovascular surgery》2017,153(2):286-295.e2
Objective
The symmetry of mitral valve tethering and regional left ventricle wall dysfunction are reported to play a fundamental role in the outcomes and long-term durability of surgical repair in ischemic mitral regurgitation (IMR). We recently demonstrated in a randomized clinical trial (the Papillary Muscle Approximation trial) the superiority of papillary muscle approximation (PMA) in combination with standard restrictive annuloplasty (RA) in severe IMR over annuloplasty alone in terms of adverse left ventricular remodeling and mitral regurgitation (MR) recurrence. This approach, however, failed to produce a survival advantage and was still plagued by a high incidence of reoperation. We therefore performed a subanalysis of the PMA trial on the basis of preoperative parameters to elucidate the value of subvalvular surgery in certain subcategories of patients with the aim of creating a decisional algorithm on the best operative strategy.Methods
We performed a subanalysis of PMA trial, evaluating 96 patients with severe IMR and eligible for myocardial revascularization randomized to PMA + RA (n = 48) versus RA alone (n = 48) in association with coronary artery bypass grafting. Endpoints included left ventricular remodeling, MR recurrence, overall mortality, reoperation, and a composite cardiac endpoint (cardiac death, stroke, reintervention, hospitalization for heart failure, or New York Heart Association class worsening). Stratification variables were preoperative symmetry of mitral valve tethering and regional wall motion abnormality.Results
PMA improved ventricular remodeling and recurrence of MR in both preoperative symmetric and asymmetric tethering and in case of inferior wall dyskinesia but did not produce an additional benefit in anterolateral wall dysfunction.Conclusions
Preoperative symmetric and asymmetric tethering and isolated inferior wall dyskinesia are an indication for subvalvular apparatus surgery in IMR. 相似文献18.
Yosuke Ishii Richard B. Schuessler Sydney L. Gaynor Kiyomi Hames Ralph J. Damiano 《The Journal of thoracic and cardiovascular surgery》2017,153(6):1357-1365
Objective
Abnormal atrial conduction has been shown to be a substrate for postoperative atrial fibrillation (POAF). This study aimed to determine the relationship between the location of the atrial reentry responsible for POAF, and degree of atrial inflammation.Methods
Normal mongrel dogs (n = 18) were divided into 3 groups: anesthesia alone (anesthesia), lateral right atriotomy (atriotomy), and lateral right atriotomy with anti-inflammatory therapy (steroid). Conduction properties of the right and left atria (RA and LA) were examined 3 days postoperatively by mapping. Activation was observed during burst pacing–induced AF. The RA and LA myeloperoxidase activity was measured to quantitate the degree of inflammation.Results
Sustained AF (>2 minutes) was induced in 5 of 6 animals in the atriotomy group, but in none in the anesthesia or steroid groups. All sustained AF originated from around the RA incision. Three of these animals had an incisional reentrant tachycardia around the right atriotomy and 2 had a focal activation arising from the RA during AF. The LA activations in these animals were passive from the RA activation. The RA activation of the atriotomy group was more inhomogeneous than that of the anesthesia group (inhomogeneity index: 2.0 ± 0.2 vs 1.0 ± 0.1, P < .01). Steroid therapy significantly normalized the RA activation after the atriotomy (1.2 ± 0.1, P < .01). The inhomogeneity of the atrial conduction correlated with the myeloperoxidase activity (r = 0.774, P < .001).Conclusions
Reentrant circuits responsible for POAF are dependent on the degree of inflammation and rotate around the atriotomy. Anti-inflammatory therapy decreased the risk of postoperative AF. 相似文献19.
Marcin Malinowski Tomasz Jazwiec Matthew Goehler Nathan Quay Jared Bush Stefan Jovinge Manuel K. Rausch Tomasz A. Timek 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1452-1461.e1
Objectives
Surgical correction of functional tricuspid regurgitation is focused on prosthetic reduction and remodeling of the tricuspid annulus. We set out to investigate the precise geometry of the human tricuspid annulus to better guide surgical therapy.Methods
Eleven human donor hearts with normal right ventricular function and without tricuspid regurgitation that were rejected for clinical transplantation were harvested. Sonomicrometry crystals were sewn around the tricuspid annulus and pressure sensors placed in the right ventricle and right atrium. The hearts were studied in the TransMedics Organ Care System (Andover, Mass) ex vivo perfusion apparatus in the right heart working model. Data were acquired at baseline and before and after bolus calcium infusion. Annular height, dimensions, strain, and curvature were calculated based on 3-dimensional crystal coordinates.Results
Maximal annular area was 997 ± 258 mm2 and minimal 902 ± 257 mm2 with contraction of 10% ± 5% at baseline and 19% ± 6% after calcium (P = .007). Segmental contractility of anterior, posterior, and septal annular regions was 7% ± 5%, 6% ± 4%, and 6% ± 3%, respectively. Only anterior region had increased contractility after calcium infusion (to 15% ± 5%; P = .023). Annulus had its high points at anteroseptal commissure and the midposterior region and lowest point in the midseptal region with maximal and minimal height of 5.0 ± 1.1 mm and 4.0 ± 1.1 mm, respectively. The greatest curvature responsible for out of plane annular bending was observed at annular high points.Conclusions
The human tricuspid annulus is a complex 3-dimensional dynamic structure with its high points and maximal degree of bending at the anteroseptal commissure and midposterior annulus. These detailed geometric data may aid the design of more physiologic annular prostheses and surgical reparative techniques. 相似文献20.
Makoto Ando Yuzo Nagase Hisaya Hasegawa Yukihiro Takahashi 《The Journal of thoracic and cardiovascular surgery》2017,153(5):1167-1177