The Annals of thoracic surgery
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Comment Letter
Acute kidney injury and cardiopulmonary bypass surgery.
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Meta Analysis Comparative Study
Off-pump versus on-pump coronary revascularization: meta-analysis of mid- and long-term outcomes.
Early outcomes for off-pump coronary artery bypass grafting (OPCAB) have been extensively compared with on-pump coronary revascularization (ONCAB); however, the long-term effects of OPCAB continue to be debated. This study aims to compare the mid-term (>1year; ≤5 years) and long-term (>5 years) survival and major adverse cardiovascular and cerebrovascular events of OPCAB versus ONCAB. ⋯ This analysis demonstrates comparable mid-term mortality and mid- to long-term morbidity between OPCAB and ONCAB. On-pump coronary artery bypass grafting may be associated with improved long-term survival when all study types are analyzed; however, analysis of only randomized controlled trials and propensity-matched studies demonstrates comparable long-term mortality between OPCAB and ONCAB.
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Multicenter Study
Hospital variation in mortality from cardiac arrest after cardiac surgery: an opportunity for improvement?
Among all postoperative complications, cardiac arrest after cardiac surgical operations has the greatest association with mortality. However, hospital variation in the ability to rescue after cardiac arrest is unknown. The purpose of this study was to characterize the impact of cardiac arrest on mortality and determine the relative impact of patient, operative, and hospital factors on failure to rescue (FTR) rates and surgical mortality after cardiac arrest. ⋯ Significant hospital variation exists in cardiac surgical mortality and FTR rates after cardiac arrest. Institutional factors appear to confer the strongest influence on the likelihood for mortality after cardiac arrest compared with patient and operative factors. Identifying best practice patterns at the highest performing centers may serve to improve surgical outcomes after cardiac arrest and improve patient quality.
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Thrombus straddling a patent foramen ovale, namely, a paradoxical embolus in transit, is a rarely identified entity signifying impending arterial embolism. We report a series of 3 patients with preoperatively or intraoperatively identified paradoxical embolus in transit. All patients underwent surgical evacuation and had unremarkable postoperative courses with no episodes of arterial embolization. Surgical embolectomy should be considered early in the treatment of paradoxical embolus in transit.