The Annals of thoracic surgery
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Multicenter Study Comparative Study
Impact of surgeon demographics and technique on outcomes after esophageal resections: a nationwide study.
Thoracic, cardiac, and general surgeons perform esophageal resections in the United States. This article examines the impact of surgeon subspecialty on outcomes after esophagectomy. ⋯ General surgeons perform the major proportion of esophagectomies in the United States. Surgeon subspecialty is not associated with the risk of complications developing but instead is associated with mortality and failure to rescue from complications. Surgeon subspecialty case mix is an important determinant of outcomes for patients undergoing esophagectomy.
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Bronchogastric conduit fistula is a rare and potentially fatal complication after esophagectomy for esophageal cancer. We report a case of a patient transferred to our institution with a complex bronchogastric conduit fistula after a thoracoscopic three-hole esophagectomy for midesophageal squamous cell carcinoma. ⋯ This was successfully reconstructed with a single-stage repair by use of an Alloderm patch reinforced with an intercostal muscle flap. At postoperative follow-up the patient is doing well and tolerating a regular diet without dysphagia.
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Comparative Study
Effect of a vascular endothelial cadherin antagonist in a rat lung transplant model.
Adherens junctions are critically important in control of endothelial cell permeability. Bβ15-42 is a peptide product of fibrin degradation that binds to vascular endothelial cadherin, the major component of endothelial adherens junctions. We tested the hypothesis that Bβ15-42 improves lung function in our rat lung transplant model. ⋯ Bβ15-42 may be a useful therapy to reduce edema and improve graft function after lung transplant, alone or as an adjunct to other therapies.
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Comparative Study
Blood conservation operations in pediatric cardiac patients: a paradigm shift of blood use.
Red blood cell transfusion is associated with high morbidity in pediatric patients undergoing cardiac operations. The aim of this study was to evaluate the clinical effects and outcomes of blood conservation for our pediatric patients undergoing cardiac operations. ⋯ Blood conservation in pediatric cardiac operations is associated with fewer ventilator days, lower inotropic scores, and shorter lengths of stay. These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations.
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Randomized Controlled Trial Multicenter Study
Tranexamic Acid in on-pump coronary artery bypass grafting without clopidogrel and aspirin cessation: randomized trial and 1-year follow-up.
Dual antiplatelet therapy is widely used in patients with coronary artery disease and increases the risk of excessive bleeding and transfusion in those undergoing coronary artery bypass grafting (CABG). ⋯ Tranexamic acid significantly reduced blood loss, major bleeding, reoperation, and allogeneic transfusion in patients undergoing primary and isolated on-pump CABG without clopidogrel and aspirin cessation.