The Annals of thoracic surgery
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Multicenter Study Comparative Study
Potts shunt in children with idiopathic pulmonary arterial hypertension: long-term results.
Idiopathic pulmonary arterial hypertension (IPAH) remains a progressive fatal disease. Palliative Potts shunt has been proposed in children displaying suprasystemic IPAH. ⋯ Palliative Potts shunt constitutes a new alternative to lung transplantation in severely ill children with suprasystemic IPAH, carrying a prolonged survival and persistent improvement in functional capacities.
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Comparative Study
Inhaled nitric oxide plus iloprost in the setting of post-left assist device right heart dysfunction.
Pulmonary hypertension and right ventricular (RV) dysfunction may complicate the implantation of a left ventricular assist device (LVAD). We examined whether inhaled vasodilators can sufficiently reduce RV afterload, avoiding the need for temporary RV mechanical support. ⋯ Inhaled vasodilators mainly affected the pulmonary vasculature. Combination treatment with inhaled NO and iloprost sufficiently decreased PVR and MPAP on the basis of an additive effect, improved RV function, and avoided the need for RV assist device.
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Extracorporeal cardiopulmonary resuscitation (ECPR) has been shown to improve survival after in-hospital pediatric cardiac arrest. We describe our experience with ECPR for refractory cardiac arrest in pediatric cardiac patients. ⋯ Extracorporeal cardiopulmonary resuscitation is an appropriate application of ECMO in pediatric cardiac patients. We report overall survival of 56%. Cardiomyopathy patients have favorable outcomes (89% survival). Biventricular patients have better outcomes then single ventricle patients (p<0.01). Extracorporeal cardiopulmonary resuscitation also seems to be a good strategy for nonpostoperative patients (71% survival). Nearly half of postoperative patients (46%) resuscitated with ECPR survived to hospital discharge.
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Our aim was to evaluate whether the workload of a surgeon, including number of operations, operative time, or number of rooms per day, influenced patient morbidity or mortality after pulmonary lobectomy. ⋯ The total number of hours a surgeon operates per day is independently associated with an increased risk of complications when performing pulmonary lobectomies. This could be related to surgeon fatigue associated with longer operative days. However, other patient variables are also associated with outcome. The relationship among these factors needs to be better understood with larger-scale models on a multiinstitutional level.