The Annals of thoracic surgery
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Increasing numbers of the very old are presenting for cardiac surgical procedures. There is little information about quality of life after hospital discharge in this group. ⋯ Octogenarians can undergo cardiac surgical procedures at a reasonable risk and show remarkable improvement in their symptoms. Elderly patients benefit from improved functional status and quality of life.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemostatic effects of aprotinin, tranexamic acid and epsilon-aminocaproic acid in primary cardiac surgery.
The effects of epsilon-aminocaproic acid (EACA) and tranexamic acid (TA) on bleeding and allogeneic transfusions, and the cost of pharmacological and transfusional treatment were compared to aprotinin (AP). ⋯ Compared to AP, TA has the same effects on bleeding and transfusions, but with a significant reduction of costs. Patients treated with EACA showed a significantly higher postoperative bleeding with an increased trend of transfusion requirement.
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A new technique of video-assisted thoracic sympathectomy through retrosternal pulmonary junction can be done safely using a scope guide and a flexible scope. Bilateral thoracic sympathectomy was performed, employing a single skin incision, in 18 patients with palmar hyperhidrosis. The advantages include minimal neuralgia and superior cosmesis.
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We describe a technique of mini-thoracotomy to plicate the paralyzed hemidiaphragm with thoracoscopic assistance. Most of the hemidiaphragm can be plicated expeditiously under direct vision with light derived from a posterior thoracoscope placed in the auscultatory triangle. Videoscopic vision is employed only occasionally when the view of the posteromedial hemidiaphragm is obscured. Continuous suture traction can be easily applied through the mini-thoracotomy, thus maintaining suture tension and enabling maximal inversion of the elevated hemidiaphragm.
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Implantable left ventricular assist device (LVAD) insertion complicated by early right ventricular (RV) failure has a poor prognosis and is generally unpredictable. ⋯ The need for perioperative RVAD support was low, only 11%. Preoperative low PAP and low RV SWI were significant risk factors for RVAD use.