The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study
Methylprednisolone in neonatal cardiac surgery: reduced inflammation without improved clinical outcome.
Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects. However, the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions. ⋯ Intravenous 30 mg/kg methylprednisolone administered before cardiopulmonary bypass resulted in high effective plasma drug concentrations and a decreased inflammatory response. However, no cardioprotective effect or better clinical outcome was noticed.
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Multicenter Study
Surgical management of neonatal atrioventricular septal defect with aortic arch obstruction.
For neonates with atrioventricular septal defect and aortic arch obstruction including coarctation of the aorta, we sought to determine whether a difference in outcomes exists after a primary neonatal versus staged surgical repair (neonatal arch repair with delayed intracardiac repair). ⋯ For neonates with atrioventricular septal defect and aortic arch obstruction, when compared with neonatal repair, a staged approach was associated with improved survival and lower morbidity.
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Randomized Controlled Trial Comparative Study
Changes in health-related quality of life in off-pump versus on-pump cardiac surgery: Veterans Affairs Randomized On/Off Bypass trial.
The relative benefits of performing coronary artery bypass graft surgery off-pump versus on-pump continue to be debated. A critical, patient-centered outcome is health-related quality of life; yet there has been limited evaluation in large-scale, multicenter trials of the off-pump versus on-pump impact upon quality of life. ⋯ For this trial's male, low-to-moderate risk, veteran population, there were no significant differences between off-pump and on-pump with regard to 1-year general and disease-specific quality of life outcomes. Both treatment arms experienced some improvements by 3 months, with continued improvements through 1-year post-bypass.
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A 51-year-old man with severe mitral regurgitation was admitted. While undergoing preoperative examination for mitral disease, he was found to have absence of the right superior vena cava and a persistent left superior vena cava. ⋯ There were no difficulties during the operation. Isolated persistent left superior vena cava is very rare, but if it is diagnosed preoperatively and an appropriate operative plan is made, MICS can be performed safely.
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Comparative Study
Routine intraoperative frozen section analysis of bronchial margins is of limited utility in lung cancer resection.
Residual disease at the bronchial margin after resection of non-small cell lung cancer (NSCLC) adversely affects survival. To ensure an R0 resection, thoracic surgeons commonly use intraoperative frozen section analysis of the bronchial margin. We hypothesize that frozen section of the bronchial margin is rarely positive and seldom changes intraoperative management. ⋯ Frozen section analysis of the bronchial margin rarely yields a positive result and infrequently changes intraoperative management in patients undergoing NSCLC resection. These data support selective use of intraoperative frozen section of bronchial margins during lobectomy for NSCLC.