The Annals of thoracic surgery
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Multicenter Study Observational Study
Nadir Hematocrit on Bypass and Rates of Acute Kidney Injury: Does Sex Matter?
Reports have associated nadir hematocrit (Hct) on cardiopulmonary bypass with the occurrence of renal dysfunction. Recent literature has suggested that women, although more often exposed to lower nadir Hct, have a lower risk of postoperative renal dysfunction. We assessed whether this relationship held across a large multicenter registry. ⋯ Lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women. Understanding of the mechanism underlying this association remains uncertain, although these results suggest the need to limit exposure to lower nadir Hct, especially for male patients.
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Multicenter Study
Greater Volume of Acute Normovolemic Hemodilution May Aid in Reducing Blood Transfusions After Cardiac Surgery.
Perioperative red blood cell transfusions (RBC) are associated with increased morbidity and mortality after cardiac surgery. Acute normovolemic hemodilution (ANH) is recommended to reduce perioperative transfusions; however, supporting data are limited and conflicting. We describe the relationship between ANH and RBC transfusions after cardiac surgery using a multi-center registry. ⋯ There is a significant association between ANH and reduced perioperative RBC transfusion in cardiac surgery. Transfusion reduction is most profound with larger volumes of ANH. Our findings suggest the volume of ANH, rather than just its use, may be an important feature of a center's blood conservation strategy.
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Multicenter Study
Epidemiology of Stroke in Pediatric Cardiac Surgical Patients Supported With Extracorporeal Membrane Oxygenation.
Stroke is a common complication of extracorporeal membrane oxygenation (ECMO), and pediatric cardiac surgical patients may be at higher risk. Epidemiology and risk factors for stroke in these patients are not well characterized. ⋯ This multicenter analysis demonstrates that pediatric cardiac surgical patients on ECMO are at high risk of stroke; younger or underweight patients and those with longer ECMO duration are at greatest risk, independent of procedural complexity. Future study is necessary to determine how anticoagulation or other clinical practices can be modified to reduce stroke incidence.
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There is controversy regarding the optimal type of lung transplant--single orthotopic lung transplantation (SOLT) versus bilateral orthotopic lung transplantation (BOLT)--for patients with idiopathic pulmonary fibrosis. We performed this study to determine which type of transplant is more appropriate for older patients with this condition. ⋯ Bilateral orthotopic lung transplantation is associated with significantly improved survival over SOLT for older patients with idiopathic pulmonary fibrosis, driven by a late survival benefit from bilateral transplantation. However, patients with a reduced preoperative functional status do not appear to derive a similar benefit from bilateral transplantation.