The Annals of thoracic surgery
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There is limited information about the effect of preoperative continuation of aspirin therapy on perioperative graft patency in patients undergoing off-pump coronary artery bypass (OPCAB). We sought to evaluate the effect of preoperative continuation of aspirin therapy on perioperative graft patency after OPCAB. ⋯ This study indicates that preoperative continuation of aspirin therapy may improve perioperative saphenous vein graft patency after OPCAB without increasing the risk of perioperative bleeding.
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Gossypiboma is a rare surgical complication, with an estimated incidence of 1/1,000 to 1/10,000 per operation. Gossypiboma is an aseptic foreign body reaction with fibrosis and granuloma formation secondary to retained surgical sponges. ⋯ We describe a patient with intrathoracic gossypiboma secondary to posterior vertebral body screw fixation after a traumatic injury. This case illustrates that thoracotomy history may not necessarily be found in intrathoracic gossypiboma.
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Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management. ⋯ The DATS management was successful in 63%. Stent migration was frequent. Posterior tracheomalacia was successfully treated in selected cases, avoiding stent placement.
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Tricuspid valve infective endocarditis (TVIE) is uncommon. Patients are traditionally treated with antibiotics alone, and indications for operation are not clearly established. We report our operative single-center experience. ⋯ In contrast to previously published reports of high operative mortality with TVIE, this experience demonstrates improved outcomes with low morbidity and mortality, particularly for native isolated TVIE. Future prospective comparisons between surgically and medically treated patients may help to further define indications and timing for operation for patients with TVIE.
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Recent studies have focused on the use of fixed-rate intraaortic balloon pumping (IABP) during cardiopulmonary bypass (CPB) to achieve pulsatile flow. Because application of an IABP catheter may represent a functional obstruction within the descending aorta, we explored the effect of IABP-pulsed CPB-perfusion with special attention to perfusion above and below the IABP balloon. ⋯ Using IABP as a surrogate to achieve pulsatile perfusion during CPB contributes significantly to lowered aortic pressure in the distal portion of aorta and impaired tissue perfusion of the kidneys. The results are focusing on effects that may contribute to organ dysfunction and acute kidney injury. Consequently, assessment of perfusion pressure distal to the balloon should be addressed whenever IABP is used during CPB.