The Annals of thoracic surgery
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Review Multicenter Study Comparative Study
Blood transfusion and infection after cardiac surgery.
Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. In all, 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. ⋯ Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (p = 0.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and preoperative and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections.
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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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Randomized Controlled Trial Comparative Study
Sustained supervised practice on a coronary anastomosis simulator increases medical student interest in surgery, unsupervised practice does not.
Given declining interest in cardiothoracic (CT) training programs during the last decade, increasing emphasis has been placed on engaging candidates early in their training. We examined the effect of supervised and unsupervised practice on medical students' interest in CT surgery. ⋯ Supervised training on low-fidelity simulators enhances interest in a career in surgery. Practice that lacks supervision does not, possibly related to the complexity of the simulated task. Mentorship efforts may need to involve sustained interaction to provide medical students with enough exposure to appreciate a surgical career.
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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.