The Annals of thoracic surgery
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Comparative Study
Outcomes of intraoperative venoarterial extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation.
The intraoperative use of cardiopulmonary bypass (CPB) in lung transplantation has been associated with increased rates of pulmonary dysfunction and bleeding complications. More recently, extracorporeal membrane oxygenation (ECMO) has emerged as a valid alternative method of support and has been our preferred method of support since March 2012. We compared early and midterm outcomes of these 2 support methods. ⋯ The use of ECMO in lung transplant is safe and in our experience was associated with decreased rates of pulmonary and renal complications, as compared with CPB. Extracorporeal membrane oxygenation has become our preferred method of intraoperative support during lung transplantation.
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Multicenter Study
Association of center volume with outcomes: analysis of verified data of European Association for Cardio-Thoracic Surgery Congenital Database.
The relation between surgical volumes and outcome in congenital heart surgery (CHS) was investigated with no clear conclusions. We sought to quantify the relationship between surgical volume and surgical performance defined as the relation between outcome and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Score and The Society of Thoracic Surgeons (STS) Morbidity Score. ⋯ Our analysis suggests that after adjustment for case mix higher programmatic volume is associated with lower rates of mortality and morbidity. The small- and medium-volume centers have higher rates of major complications. When complications occurred the chance of rescue is higher in large-volume centers.
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Comparative Study
Differential outcomes with early and late repeat transplantation in the era of the lung allocation score.
Rates of repeat lung transplantation have increased since implementation of the lung allocation score (LAS). The purpose of this study is to compare survival between repeat (ReTx) and primary (LTx) lung transplant recipients in the LAS era. ⋯ Late lung retransplantation appears to be as beneficial as primary transplantation in propensity-matched patients. However, survival is severely diminished in those retransplanted less than 90 days after primary transplantation. The utility of early retransplantation needs to be carefully weighed in light of risks.
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Multicenter Study
The association of chronic lung disease with early mortality and respiratory adverse events after aortic valve replacement.
We studied the association between components of chronic lung disease (CLD) assessment and operative outcomes in patients undergoing aortic valve replacement (AVR) for aortic stenosis. ⋯ CLD is associated with adverse operative outcomes in selected patients with aortic stenosis undergoing AVR. FEV1, DLCO, and PaO2 may add important information to current risk adjustment models beyond the broad CLD classification.
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A 64-year-old woman underwent tracheal sleeve resection for adenocarcinoma. Thirteen months later minimal granuloma occurred at the anastomosis. Subsequently she had dyspnea from obstruction caused by the increasing size of the granuloma, which necessitated 4 repeated endobronchial debulking procedures and topical mitomycin C (MMC) application. ⋯ Eventually, the granulation tissue and pledgeted sutures were removed from the anastomotic site using rigid bronchoscopy. Follow-up after 8 months showed no recurrence of symptoms, and the granuloma had resolved. Despite improvements in surgical suture material, removal of stitches should still be considered in the management of anastomotic obstruction caused by indolent and intractable granulation after tracheal resection or bronchoplasty.