The Experts below are selected from a list of 4962 Experts worldwide ranked by ideXlab platform
Jose E Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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Ascending Aorta and aortic root reoperations are outcomes worse than first time Surgery
The Annals of Thoracic Surgery, 2010Co-Authors: Jacobo Silva, Luis Maroto, Manuel Carnero, Isidre Vilacosta, Javier Cobiella, Enrique Villagran, Jose E RodriguezAbstract:Background The aim of this study was to analyze Surgery and survival data in the midterm after aortic root and (or) Ascending Aorta reoperations and compare these results with those obtained after first time Surgery. Methods Over a 6-year period, 365 patients underwent an aortic root and (or) Ascending Aorta Surgery procedure at our center. Mean patient age was 63.1 ± 25.5 years; 27.1% were women. Fifty-eight patients had had prior Ascending Aorta and (or) aortic valve Surgery (group I) and the remaining 307 patients were assigned to an initial Surgery group (II). The reoperative procedures were Bentall in 45 (77.6%), Ascending Aorta and valve replacement in 8 (13.8%), and Ascending Aorta replacement in 5 (8.6%). Results The reoperation group showed a worse preoperative risk profile indicated by a higher logistic European system for cardiac operative risk evaluation: group I (26.9) versus group II (9.9) ( p p = 0.18; relative risk 1.9 [0.8 to 4.6]). After adjusting for the different variables, reoperation could not be identified as an independent predictor of postoperative morbidity. Survival rates (including in-hospital mortality) were lower in group I at one year (77.9 ± 1.11% vs 91.9 ± 0.3%) and at 3 years (75.3 ± 0.11% vs 88.9 ± 0.03% [log-rank p = 0.005]). In the multivariate analysis, reoperation ( p = 0.01; hazard ratio 2.6 [1.2 to 5.3]) was a determining factor for survival once corrected for variables predicting mortality during follow-up. Conclusions Reoperations on the Ascending Aorta and aortic root showed acceptable morbidity and mortality. Their midterm survival was lower than for patients not requiring a repeat operation.
Ehsan Natour - One of the best experts on this subject based on the ideXlab platform.
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stentless full root bioprosthesis in Surgery for complex aortic valve Ascending aortic disease a single center experience of over 300 patients
European Journal of Cardio-Thoracic Surgery, 2008Co-Authors: O Dapunt, Jerry Easo, P Holzl, Peter Murin, M Sudkamp, Michael Horst, Ehsan NatourAbstract:Objective: The technically demanding full root aortic valve replacement necessitating coronary ostia reimplantation apparently leads to hesitation by some surgeons despite the superior hemodynamics and excellent long-term clinical performances of the stentless xenografts. Clinical data of stentless full root replacements was retrospectively analyzedin this perspective for validation.Methods:From November 1999 to March 2007, 317 adult patients (male: 196, female, 121) underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement. Two hundred and three patients received an isolated root replacement or a root and Ascending aortic replacement (ARR). In 114 patients a variety of concomitant procedures including coronary artery bypass grafting (n = 32), mitral valve repair (n = 11) and aortic arch replacement (n = 36) were performed. (ARR+). Results: Mean patient age was 70.3 10.2 years (range 17—94 years), 97 patients were 75 and older at time of procedure. Mean operative time for the ARR was 190 57 min with a clamp time of 88 27 min. Mean operative time for ARR+ groupwas282 93 minwith anaverageclamptimeof110 32 min.Overalloperativemortalitywas7.9%(25/317),forARRit was5.4%(11/203). Mean ICU stay was 4.9 8.1 days, mean hospital stay being 9.8 8.1 days. Necessity for bailout bypass Surgery among patients with ARR was low at 1.5% (3/203) comparable to stented xenograft implantations. Echocardiography demonstrated excellent clinical results with low transvalvular gradients especially when a single suture inflow anastomosis technique was used. Conclusions: Full root stentless valve implantation preserving porcine root integrity is a valuable option in aortic valve/Ascending Aorta Surgery. Though technically a more challenging operation, it does not lead to increased perioperative morbidity and mortality and can be beneficial mainly for elderly patients with small aortic roots with or without aortic root pathology. # 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reseved.
Rebecca F Gottesman - One of the best experts on this subject based on the ideXlab platform.
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length of red cell unit storage and risk for delirium after cardiac Surgery
Anesthesia & Analgesia, 2014Co-Authors: Charles H Brown, Maura A Grega, Ola A Selnes, Guy M Mckhann, Ashish S Shah, Andrew Laflam, William J Savage, Steven Mark Frank, Charles W Hogue, Rebecca F GottesmanAbstract:BACKGROUND: The time that red cell units are stored before transfusion may be associated with postoperative complications, although the evidence is conflicting. However, the association between the length of red cell unit storage and postoperative delirium has not been explored. We hypothesized that the length of storage of transfused red cell units would be associated with delirium after cardiac Surgery. METHODS: We conducted a case-control study in which patients undergoing coronary artery bypass, valve, or Ascending Aorta Surgery with cardiopulmonary bypass at Johns Hopkins from 2005 to 2011 were eligible for inclusion. Patients were excluded if they did not receive red cell units, received >4 red cell units during hospitalization, received any transfusion after the first postoperative day, or received red cell units that were not exclusively stored for ≤14 days or >14 days. Eighty-seven patients met transfusion-related inclusion criteria and developed postoperative delirium. Controls who did not develop delirium were selected from the same source population of eligible patients and were matched 1:1 based on age (± 5 years), 2- to 2.5-year band of date of Surgery, and surgical procedure. For each patient, we calculated the average storage duration of all transfused red cell units. The primary outcome was odds of delirium in patients who were transfused red cell units with exclusive storage duration >14 days compared with that of ≤14 days. Secondary outcomes were odds of delirium with each increasing day of average red cell unit storage duration. We used conditional multivariable regression to test our hypotheses. RESULTS: In conditional multivariable analysis of 87 case-control pairs, there was no difference in the odds of patients developing delirium if they were transfused red cell units with an exclusive storage age >14 days compared with that ≤14 days (odds ratio [OR] 1.83; 95% confidence interval, 0.73–4.58, P = 0.20). Each additional day of average red cell unit storage beyond 14 days was associated with a 1.01- to 1.13-fold increase in the odds of postoperative delirium (OR, 1.07; P = 0.03). Each additional day of average storage beyond 21 days was associated with a 1.02- to 1.23-fold increase in the odds of postoperative delirium (OR, 1.12; P = 0.02). CONCLUSIONS: Transfusion of red cell units that have been stored for >14 days is not associated with increased odds of delirium. However, each additional day of storage >14 or 21 days may be associated with increased odds of postoperative delirium in patients undergoing cardiac Surgery. More research is needed to further characterize the association between delirium and storage duration of transfused red cell units.
Jacobo Silva - One of the best experts on this subject based on the ideXlab platform.
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Ascending Aorta and aortic root reoperations are outcomes worse than first time Surgery
The Annals of Thoracic Surgery, 2010Co-Authors: Jacobo Silva, Luis Maroto, Manuel Carnero, Isidre Vilacosta, Javier Cobiella, Enrique Villagran, Jose E RodriguezAbstract:Background The aim of this study was to analyze Surgery and survival data in the midterm after aortic root and (or) Ascending Aorta reoperations and compare these results with those obtained after first time Surgery. Methods Over a 6-year period, 365 patients underwent an aortic root and (or) Ascending Aorta Surgery procedure at our center. Mean patient age was 63.1 ± 25.5 years; 27.1% were women. Fifty-eight patients had had prior Ascending Aorta and (or) aortic valve Surgery (group I) and the remaining 307 patients were assigned to an initial Surgery group (II). The reoperative procedures were Bentall in 45 (77.6%), Ascending Aorta and valve replacement in 8 (13.8%), and Ascending Aorta replacement in 5 (8.6%). Results The reoperation group showed a worse preoperative risk profile indicated by a higher logistic European system for cardiac operative risk evaluation: group I (26.9) versus group II (9.9) ( p p = 0.18; relative risk 1.9 [0.8 to 4.6]). After adjusting for the different variables, reoperation could not be identified as an independent predictor of postoperative morbidity. Survival rates (including in-hospital mortality) were lower in group I at one year (77.9 ± 1.11% vs 91.9 ± 0.3%) and at 3 years (75.3 ± 0.11% vs 88.9 ± 0.03% [log-rank p = 0.005]). In the multivariate analysis, reoperation ( p = 0.01; hazard ratio 2.6 [1.2 to 5.3]) was a determining factor for survival once corrected for variables predicting mortality during follow-up. Conclusions Reoperations on the Ascending Aorta and aortic root showed acceptable morbidity and mortality. Their midterm survival was lower than for patients not requiring a repeat operation.
Jaekwan Song - One of the best experts on this subject based on the ideXlab platform.
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long term predictors of descending Aorta aneurysmal change in patients with aortic dissection
Journal of the American College of Cardiology, 2007Co-Authors: Jongmin Song, Sungdoo Kim, Jeonghoon Kim, Mijeong Kim, Dukhyun Kang, Joon Beom Seo, Taehwan Lim, Jae Won Lee, Meonggun Song, Jaekwan SongAbstract:Objectives We sought to demonstrate the long-term natural course of descending Aorta dilation after acute aortic dissection (AD) and identify early predictors for late aneurysmal change. Background Aneurysmal dilation of the Aorta is a critical late complication in AD patients. Methods Contrast-enhanced computed tomography (CT) was performed during the acute phase in 100 AD patients, comprising 51 type 1 who underwent Ascending Aorta Surgery and 49 type 3 AD patients. Clinical observation was conducted for 53 ± 26 months, and CT was repeated for 31 ± 27 months. Results Aneurysm (diameter ≥60 mm) occurred in 14.4%, 8.2%, 4.1%, and 3.1% of patients at the upper descending thoracic Aorta (UT), mid descending thoracic Aorta (MT), lower descending thoracic Aorta (LT) and abdominal Aorta (AA), respectively. Of 53 patients in whom CT was repeated for ≥2 years, the rates of Aorta diameter enlargement at the UT, MT, LT, and AA levels were 3.43 ± 3.66 mm/year, 3.21 ± 2.70 mm/year, 2.62 ± 2.19 mm/year, and 1.93 ± 3.13 mm/year, respectively (p Conclusions The UT is the major site of late aneurysmal dilation. A large UT false lumen diameter on the initial CT portends late aneurysm and adverse outcome warranting early intervention.
