The Annals of thoracic surgery
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Comparative Study
Early renal replacement therapy during pediatric cardiac extracorporeal support increases mortality.
Acute kidney injury is a common comorbidity for children placed on extracorporeal membrane oxygenation (ECMO) because of primary cardiac disease. Continuous venovenous hemofiltration (CVVH) can optimize fluid status and lessen inflammatory response during ECMO. However, published data are derived primarily from children without primary cardiac disease. ⋯ Early CVVH in pediatric cardiac patients requiring ECMO is associated with increased mortality. Early CVVH in the cardiac ECMO population does not appear justified.
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Comparative Study
Long-term fate of patients discharged to extended care facilities after cardiovascular surgery.
The Society of Thoracic Surgeons predictive algorithms can be used to help patients understand the risks in having a surgical procedure. However, elderly patients are frequently more concerned about the quality of their remaining life and whether they will return home. Currently, we have no predictors of which patients are likely to return to independent living after surgery. We followed patients discharged home or to an extended care facility to determine which patients were most likely to return home and be alive at one year. ⋯ Many patients discharged to extended care do not return to their previous lifestyle; only 30.8% of those requiring care in a LTAC facility are alive at home at 1 year.
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Comparative Study
Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era.
In the era of destination continuous flow left ventricular assist devices (LVAD), the decision of whether a patient will tolerate isolated LVAD support or will need biventricular support (BIVAD) can be challenging. Incorrect decision making with delayed right ventricular (RV) assist device implantation results in increased morbidity and mortality. Continuous flow LVADs have been shown to decrease pulmonary hypertension and improve RV function. We undertook this study to determine predictors in the continuous flow LVAD era that identify patients who are candidates for isolated LVAD therapy as opposed to biventricular support. ⋯ We present a preoperative risk calculator to determine suitability of a patient for isolated LVAD support in the current continuous flow ventricular assist device era.
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Comparative Study
The role of cardiac resynchronization therapy for arterial switch operations complicated by complete heart block.
As mortality in patients with D-loop transposition of the great arteries (D-TGA) has decreased after the arterial switch operation (ASO), the focus has shifted to higher risk groups and outcomes that impact long-term morbidity and mortality, such as left ventricular (LV) dysfunction. We sought to examine the perioperative factors associated with LV dysfunction in patients with D-TGA and ventricular septal defects (VSD) after ASO. ⋯ Left ventricular dysfunction after surgical repair for D-TGA/VSD is low, with heart block and pacemaker insertion playing a significant role. The LV function improved after patients were upgraded to a CRT device.
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Comparative Study
Single-incision thoracoscopic lobectomy and segmentectomy with radical lymph node dissection.
Reports of single-incision thoracoscopic lobectomy and segmentectomy are rare. In this article, we present our experience with single-incision thoracoscopic lobectomy and segmentectomy and radical mediastinal lymph node dissection. ⋯ Single-port VATS lobectomy and segmentectomy is safe and feasible for selected patients.