The Annals of thoracic surgery
-
Comparative Study
The paracorporeal artificial lung improves 5-day outcomes from lethal smoke/burn-induced acute respiratory distress syndrome in sheep.
Our low-impedence, paracorporeal artificial lung (PAL) prototype is well-tolerated in-series with the normal sheep pulmonary circulation. Using our lethal dose 80% to 100% smoke/burn acute respiratory distress syndrome (ARDS) sheep model, we compared PAL to volume-controlled mechanical ventilation (VCMV) in a prospective, randomized, controlled, unblinded, 5-day outcome study. ⋯ In a prospective, randomized, controlled, unblinded, outcomes study, PAL decreased ventilator-induced lung injury in a lethal dose 80% to 100% ARDS model to improve 5-day survival.
-
Comparative Study
Is it safe to train residents to perform cardiac surgery?
The impact of surgical training on patient outcomes in cardiac surgery is unknown. ⋯ In this analysis of our experience with residency training, the operative morbidity and mortality in CABG and AVR patients was similar for residents and staff. Training residents to perform cardiac surgery appears to be safe.
-
Comparative Study
PulseCO: a less-invasive method to monitor cardiac output from arterial pressure after cardiac surgery.
Cardiac output is often monitored after cardiac operations with a pulmonary artery catheter. A new method has been introduced that measures cardiac output by lithium dilution (LiDCO) and uses these data to calibrate a system (PulseCO) that calculates cardiac output continuously from the energy of the arterial pressure waveform. It is unknown whether PulseCO measurements are valid early after cardiac surgery when changes in temperature and vascular tone or intermittent use of the arterial line for blood sampling may occur. This study assessed the reliability of cardiac output determinations by PulseCO in the first 8 hours after cardiac surgery. ⋯ PulseCO measurements remain reliable without recalibration for at least 8 hours after cardiac surgery and may offer a less-invasive approach for early postoperative cardiac output monitoring.
-
Obesity is epidemic in the United States and afflicts 97 million adults. Prior single center studies have been contradictory as to obese patients having higher risks with coronary artery bypass operations. Our objective was to assess the independent effect of both moderate (body mass index [BMI], 35 to 39.9) and extreme (BMI > or = 40) obesity on bypass operation outcomes using the Society of Thoracic Surgeons National Cardiac Database. ⋯ Extreme obesity (body mass index > or = 40) is a significant independent predictor for adverse outcomes and prolonged hospitalization after coronary artery bypass operation.
-
Cardiac resynchronization therapy for the treatment of medically refractory heart failure requires coronary sinus lead placement for left ventricular pacing. Coronary sinus lead placement is technically difficult with success rates reported between 53% to 98% and implantation times ranging from 90 minutes to 5 hours. ⋯ Transesophageal echocardiography may improve the success rate with coronary sinus lead placement and decrease the operative time required. This should be used with caution, however, as sedation, possible intubation, and esophageal manipulation have potentially morbid consequences in patients with advanced congestive heart failure.