The Annals of thoracic surgery
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Self-expandable stents loaded with 125I (iodine 125) seeds may combine the advantages of the immediate relief of esophageal dysphagia with stent placement and radiation therapy with brachytherapy. We compared the self-expanding irradiation stent with a conventional self-expandable covered stent in patients with malignant dysphagia due to recurrent esophageal cancer. ⋯ This study indicated that the radiation stent had a potential benefit of a longer dysphagia relief period. However, no significant survival benefits were observed in the radiation stent group and the high incidence rate of massive hemorrhages further limited its application in patients with malignant dysphagia due to recurrent esophageal cancer.
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Comparative Study
Better short-term outcome by using sutureless valves: a propensity-matched score analysis.
Sutureless aortic valve prostheses have the potential of shortening ischemic time. However, whether shorter operative times may also result in improved patient outcomes and have an effect on hospital costs remains to be established. ⋯ A shorter procedural time in the sutureless group is associated with better clinical outcomes and reduced hospital costs.
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Multicenter Study
Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs.
New-onset postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery. However, the magnitude of POAF on length of stay, resource utilization, and readmission rates remains an area of clinical interest. The purpose of this study was to examine the risk-adjusted impact of POAF on measures of mortality, hospital resources, and costs among multiple centers. ⋯ New onset POAF is associated with increased risk-adjusted mortality, hospital costs, and readmission rates. Protocols to reduce the incidence of POAF have the potential to significantly impact patient outcomes and the delivery of high-quality, cost-effective patient care.
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Recombinant activated factor VII (rFVIIa) decreases requirements for allogeneic blood transfusion and chest reexploration in patients undergoing cardiac surgery. Whether rFVIIa increases the risk of postoperative adverse events is unclear. We tested whether rFVIIa administration was associated with increased mortality and neurologic and renal morbidity in patients undergoing cardiac surgery. Risk of thromboembolic complications and the dose-response of rFVIIa on mortality and morbidity were also evaluated. ⋯ Administration of rFVIIa is associated with increased mortality and renal morbidity in patients undergoing cardiac surgery.
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Comparative Study
Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease.
In 2012 the United States Food and Drug Administration approved implantation of a magnetic sphincter to augment the native reflux barrier based on single-series data. We sought to compare our initial experience with magnetic sphincter augmentation (MSA) with laparoscopic Nissen fundoplication (LNF). ⋯ MSA results in similar objective control of GERD, symptom resolution, and improved quality of life compared with LNF. MSA seems to restore a more physiologic sphincter that allows physiologic reflux, facilitates belching, and creates less bloating and flatulence. This device has the potential to allow individualized treatment of patients with GERD and increase the surgical treatment of GERD.