The Annals of thoracic surgery
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The prevention of major pulmonary events (MPEs) after pneumonectomy may minimize postoperative mortality rates. The purpose of this study was to identify preoperative and perioperative factors associated with the development of MPEs after pneumonectomy to help predict which patients are at increased risk for MPEs. ⋯ Mortality after pneumonectomy increased significantly with the development of an MPE. Patients who continue to smoke within 1 month of operation are at an increased risk for developing an MPE. Interventions to minimize MPEs may minimize the mortality rate after pneumonectomy.
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We report a case of chronic empyema and bronchopleural fistula after lobectomy for tuberculosis. The patient had undergone four different surgical procedures to correct his bronchopleural fistula during an interval of seven years. Finally, he had a successful closure of the fistula using the transsternal transpericardial approach.
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Ventricular Assist Device (VAD) is an accepted treatment as a bridge to cardiac transplantation, and may be of help in patients as destination therapy for end-stage cardiac failure. The low output state associated with end-stage cardiac failure predisposes patients to renal dysfunction and the need for short-term renal support. The use of cardiopulmonary bypass for VAD insertion, VAD, and hemofiltration expose the blood to mechanical trauma and activated inflammatory cascades that can result in hemolysis. This produces free hemoglobin, a known nephrotoxin; this is a further renal insult. This study assesses the effect of VAD alone and in combination with continuous veno-venous hemofiltration (CVVHF) on hemolysis. ⋯ Thoratec VAD was associated with a mild degree of hemolysis. This was worsened by concomitant use of CVVHF. The effect was accentuated if the same CVVHF circuit was used for over 48 hours but was reversible within 24 hours of stopping the hemofilter.