The Annals of thoracic surgery
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Comparative Study
Transvalvular pacemaker leads increase the recurrence of regurgitation after tricuspid valve repair.
The impact of a transvalvular pacemaker lead on the progression of tricuspid regurgitation (TR) after tricuspid valve (TV) repair has not been clearly demonstrated. The aim of this study was to evaluate the presence of a transvalvular pacemaker lead as a risk factor for TR after TV repair in a large patient cohort. ⋯ In patients undergoing tricuspid valve surgery, the presence of a transvenous pacemaker implanted either preoperatively or within 30 days of surgery is associated with a significantly increased risk of persistent or recurrent TR at late follow-up.
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Multicenter Study Comparative Study
Variation in ventilation time after coronary artery bypass grafting: an analysis from the society of thoracic surgeons adult cardiac surgery database.
Short postoperative ventilation times are accepted as a marker of quality. This analysis assesses center level variation in postoperative ventilation time in a subset of patients undergoing isolated coronary artery bypass grafting (CABG). ⋯ After adjustment for severity of illness, substantial inter-center variation exists in postoperative ventilation time in this subset of patients undergoing isolated CABG. This finding represents an opportunity for multi-institutional quality improvement initiatives designed to limit variations in ventilator management and achieve the shortest possible ventilation times for all patients, thus benefiting both clinical outcomes and resource utilization.
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Comparative Study
Revascularization for the right coronary artery territory in off-pump coronary artery bypass surgery.
Graft selection for the right coronary artery territory remains controversial. The objective of this study was to analyze outcomes from revascularization of the right coronary artery territory using the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), or a saphenous vein graft (SVG). ⋯ Arterial grafts should be considered the first choice for right coronary artery territory revascularization in off-pump coronary artery bypass. However, SVG should be considered when proximal stenosis is less than 90%.
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Comparative Study
A protocol-driven approach to cardiac reoperation reduces mortality and cardiac injury at the time of resternotomy.
The purpose of this study was to determine whether an established protocol-driven approach to cardiac reoperations would improve patient outcomes and reduce resternotomy injuries. ⋯ A protocol-driven approach to cardiac reoperations is associated with reduced cardiac injury upon resternotomy and decreased mortality. The protocol-driven use of routine preoperative computed tomography angiography, alternative cannulation planning, avoidance of prior internal mammary artery grafts, and the early initiation of cardiopulmonary bypass before sternotomy for selected cases should be considered to improve operative results and efficiency.
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A 35-year-old woman at 13 weeks gestation presented with adenoid cystic carcinoma of the distal left mainstem bronchus with chronic collapse of the left lung requiring carinal pneumonectomy. The extent of the tumor and need for significant retraction during dissection and pneumonectomy resulted in the need for cardiopulmonary bypass. The patient underwent successful left carinal pneumonectomy and subsequently delivered a healthy baby.