The Annals of thoracic surgery
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Comparative Study
Incidence and risk factors of postoperative vocal cord paralysis in 987 patients after cardiovascular surgery.
Vocal cord paralysis (VCP) after cardiovascular surgery can affect the postoperative outcome. The aim of the present study was to clarify the incidence of VCP after cardiovascular surgery and the relationship between the surgery characteristics and the risk of VCP. ⋯ Aortic procedures and prolonged operation increase the risk of VCP. Severe VCP tended to be associated with aortic surgery and intubation for more than 100 hours.
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Iatrogenic esophageal perforation after endoscopy or surgery can be a devastating event. Traditional therapy has most often consisted of operative repair of the esophagus. This investigation summarizes our experiences treating iatrogenic intrathoracic perforations of the esophagus using an occlusive removable esophageal stent. ⋯ Endoluminal esophageal stent placement is an effective method for the treatment of acute, iatrogenic perforations of the intrathoracic esophagus. These stents result in rapid leak occlusion, provide the opportunity for early oral nutrition, may significantly reduce hospital length of stay, are removable, and avoid the potential morbidity of operative repair.
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Randomized Controlled Trial
Postconditioning the human heart with adenosine in heart valve replacement surgery.
The effect of adenosine postconditioning on myocardial protection in cardiac surgery remains uncertain. The present study evaluated the safety, feasibility, and beneficial effect of adenosine postconditioning as an adjunct to predominantly used cold-blood cardioplegic myocardial protection method in the setting of heart valve replacement operations. ⋯ A 1.5-mg/kg bolus administration of adenosine through an arterial catheter immediately after the aorta cross-clamp is removed is feasible and well tolerated in patients undergoing heart valve replacement. An adenosine postconditioning adjunct to high potassium cold blood myocardial protection is related to less troponin I release, less inotropic drug use, and shorter ICU stay.
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Several variations of the total cavopulmonary connection (TCPC) have been investigated for favorable fluid mechanics and flow distribution. This study presents a hemodynamically optimized TCPC configuration code-named "OptiFlo." Featuring bifurcated vena cava (superior venacava to inferior vena cava SVC/IVC), it was designed to lower the fluid mechanical power losses in the connection and to ensure proper hepatic blood perfusion to both lungs. ⋯ The OptiFlo TCPC design exhibits lower power losses with better adaptive distribution of hepatic blood to both lungs and lower blood flow disturbances compared with the planar one-diameter offset TCPC model. Its significantly superior hemodynamic performance at higher cardiac outputs (exercise) rationalizes further design and feasibility studies toward a workable clinical model.
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Comparative Study
Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer.
Lobectomy for patients with clinical stage I non-small cell lung cancer (NSCLC) can be performed by thoracotomy or by video-assisted thoracoscopic surgery (VATS). We compared the operative characteristics and postoperative course for patients with clinical stage I NSCLC who underwent lobectomy by VATS or thoracotomy. ⋯ Patients undergoing VATS lobectomy for clinical stage I NSCLC, despite having more comorbidities, had fewer postoperative complications. The approaches are equivalent in operative time, blood loss, length of stay, and survival rate. Compared with thoracotomy, VATS lobectomy for patients with clinical stage I NSCLC appears to be a less morbid operation.