The Annals of thoracic surgery
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Comparative Study
Disclosure of physician-specific behavior improves blood utilization protocol adherence in cardiac surgery.
Evidence indicates that a transfusion (Tx) trigger hemoglobin (Hgb) value of 8 gm/dL may be safer than a more liberal Tx trigger in cardiac surgery (CS) patients. We hypothesized that weekly physician feedback would improve adherence to such a protocol, but that the public identification of individual physician behavior would have an additive effect. ⋯ Blood transfusion protocol adherence improves when weekly feedback is provided. Identifying individual surgeon behavior improves adherence to a greater degree. Routine presentation of quality metrics with identification of individual physician-specific behavior may be the most effective way to accomplish performance improvement.
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Comparative Study
Equivalency of right internal thoracic artery and right gastroepiploic artery composite grafts: five-year outcomes.
We compared 5-year graft patency rates and long-term clinical outcomes after myocardial revascularization using the right internal thoracic artery (RITA) and right gastroepiploic artery (RGEA) as a Y-composite graft anastomosed to the in situ left internal thoracic artery. ⋯ Total arterial revascularization using RITA and RGEA Y-composite grafts based on the in situ left internal thoracic artery showed comparable results in terms of 5-year angiographic patency rates and long-term clinical outcomes.
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Randomized Controlled Trial Comparative Study
Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy: a prospective study.
The issue of phrenic nerve preservation during pneumonectomy is still an unanswered question. So far, its direct effect on immediate postoperative pulmonary lung function has never been evaluated in a prospective trial. ⋯ Our results show that phrenic nerve palsy causes a significant impairment of dynamic lung volumes during the early postoperative period after pneumonectomy. Therefore, in these already compromised patients, intraoperative phrenic nerve injury should be avoided whenever possible.
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Comparative Study
Cerebral blood flow autoregulation is preserved after hypothermic circulatory arrest.
Patients undergoing aortic operations with hypothermic circulatory arrest (HCA) may require prolonged rewarming, a maneuver associated with impaired cerebral blood flow (CBF) autoregulation. The purpose of this study was to determine the effects of HCA on CBF autoregulation with a validated method based on near-infrared spectroscopy. ⋯ During aortic reconstructive operations, CBF autoregulation is preserved during the cooling phase of the procedure in patients undergoing HCA. Perfusion maneuvers associated with HCA may be protective against impaired autoregulation during rewarming compared with the non-HCA group.