The Annals of thoracic surgery
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Dialysis-dependent renal failure occurs infrequently after cardiac surgery but leads to substantial morbidity and mortality. In contrast, milder degrees of acute kidney injury (AKI), based on small increases in serum creatinine, occur frequently but the independent impact of mild AKI on outcome remains unclear. ⋯ Patients with even mild degrees of AKI have increased mortality and morbidity compared with their matched counterparts. Interventions that prevent or mitigate AKI after cardiac surgery can yield substantial clinical benefit.
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Lung volume reduction with valves is increasingly used to treat selected patients with severe emphysema. The indications for this procedure have been previously described; however, its contraindications have not yet been conclusively established. This case highlights the potentially severe complications of endobronchial one-way valve placement in the setting of a previous pleurodesis.
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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.