The Annals of thoracic surgery
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Comparative Study
Transvalvular pacemaker leads increase the recurrence of regurgitation after tricuspid valve repair.
The impact of a transvalvular pacemaker lead on the progression of tricuspid regurgitation (TR) after tricuspid valve (TV) repair has not been clearly demonstrated. The aim of this study was to evaluate the presence of a transvalvular pacemaker lead as a risk factor for TR after TV repair in a large patient cohort. ⋯ In patients undergoing tricuspid valve surgery, the presence of a transvenous pacemaker implanted either preoperatively or within 30 days of surgery is associated with a significantly increased risk of persistent or recurrent TR at late follow-up.
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Comparative Study
Early renal replacement therapy during pediatric cardiac extracorporeal support increases mortality.
Acute kidney injury is a common comorbidity for children placed on extracorporeal membrane oxygenation (ECMO) because of primary cardiac disease. Continuous venovenous hemofiltration (CVVH) can optimize fluid status and lessen inflammatory response during ECMO. However, published data are derived primarily from children without primary cardiac disease. ⋯ Early CVVH in pediatric cardiac patients requiring ECMO is associated with increased mortality. Early CVVH in the cardiac ECMO population does not appear justified.
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Comparative Study
A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer.
Nodal upstaging after surgical intervention for non-small cell lung cancer (NSCLC) occurs when unsuspected lymph node metastases are found during the final evaluation of surgical specimens. Recent data from The Society of Thoracic Surgery (STS) database demonstrated significantly lower nodal upstaging after thoracoscopic (VATS) lobectomy than after thoracotomy. STS data, however, may be biased from voluntary reporting, and survival was not investigated. We used a complete national registry to compare nodal upstaging and survival after lobectomy by VATS or thoracotomy. ⋯ National data confirm that nodal upstaging was lower after VATS than after open lobectomy for clinical stage I NSCLC. Multivariate survival analysis, however, showed no difference in survival, indicating that differences in nodal upstaging result from patient selection for reasons not captured in our registry.
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Comparative Study
Long-term fate of patients discharged to extended care facilities after cardiovascular surgery.
The Society of Thoracic Surgeons predictive algorithms can be used to help patients understand the risks in having a surgical procedure. However, elderly patients are frequently more concerned about the quality of their remaining life and whether they will return home. Currently, we have no predictors of which patients are likely to return to independent living after surgery. We followed patients discharged home or to an extended care facility to determine which patients were most likely to return home and be alive at one year. ⋯ Many patients discharged to extended care do not return to their previous lifestyle; only 30.8% of those requiring care in a LTAC facility are alive at home at 1 year.
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Comparative Study
The role of cardiac resynchronization therapy for arterial switch operations complicated by complete heart block.
As mortality in patients with D-loop transposition of the great arteries (D-TGA) has decreased after the arterial switch operation (ASO), the focus has shifted to higher risk groups and outcomes that impact long-term morbidity and mortality, such as left ventricular (LV) dysfunction. We sought to examine the perioperative factors associated with LV dysfunction in patients with D-TGA and ventricular septal defects (VSD) after ASO. ⋯ Left ventricular dysfunction after surgical repair for D-TGA/VSD is low, with heart block and pacemaker insertion playing a significant role. The LV function improved after patients were upgraded to a CRT device.