The Annals of thoracic surgery
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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.
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Extracorporeal membrane oxygenation (ECMO) support is often required in the management of perioperative congenital heart surgery (CHS) patients. However, 24-hour in-hospital congenital cardiac surgical coverage (24-CCSC) is not available at all institutions. The purpose of this study is to evaluate the effect of 24-CCSC on perioperative ECMO outcomes in CHS patients. ⋯ The presence of 24-CCSC significantly decreased the rate of mortality in children supported with ECMO after undergoing cardiac surgery, as well as cardiac arrhythmias and pulmonary complications for perioperative CHS patients receiving ECMO support. This study demonstrates that CHS programs would benefit from 24-CCSC in the care of this critically ill patient population.
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The systemic morphologic right ventricle (RV) in congenitally corrected transposition of the great arteries or after atrial switch for transposition of the great arteries is associated with late ventricular failure. Although the role of the left ventricular assist device (LVAD) in supporting the failing LV is established, the indications and outcomes of using LVAD in a systemic RV remain unclear. We assessed the role of a third-generation LVAD for systemic RV support. ⋯ The third-generation VAD provides durable support for systemic RV failure as a bridge to transplant and as a strategy to reduce pulmonary vascular resistance. Although concomitant subpulmonic LV failure is common, systemic RV support alone was achieved in all patients.