The Annals of thoracic surgery
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Comparative Study
Outcomes before and after implementation of a pediatric rapid-response extracorporeal membrane oxygenation program.
Rapid-response extracorporeal membrane oxygenation (RR-ECMO) has been implemented at select centers to expedite cannulation for patients placed on ECMO during extracorporeal cardiopulmonary resuscitation (ECPR). In 2008, we established such a program and used it for all pediatric venoarterial ECMO initiations. This study was designed to compare outcomes before and after program implementation. ⋯ Implementation of a pediatric RR-ECMO program for venoarterial ECMO initiation was associated with reduced neurologic complications but not improved survival during the first 3 years of program implementation. These data suggest that development of a coordinated system for rapid ECMO deployment may benefit both ECPR and non-ECPR patients, but further efforts are required to improve survival.
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Comparative Study
Visceral pleural invasion is not predictive of survival in patients with lung cancer and smaller tumor size.
Visceral pleural invasion (VPI) is used as an indicator of adverse prognosis in non-small cell lung cancer (NSCLC). The purpose of this retrospective study was to evaluate the impact of VPI on disease-free survival (DFS) and overall survival (OS) in patients with node-negative NSCLC. ⋯ The effect of VPI on survival in NSCLC varies greatly with tumor size, with VPI not strongly associated with OS or DFS in tumors smaller than 5 cm, but showing large negative effects on DFS for stage T2b and stage T3 tumors. Using VPI to upstage T1 tumors to a higher T stage is not warranted because it would misrepresent these VPI-T stage subgroup effects.
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Superior vena cava oxygen saturation monitoring in the early postoperative period after the Norwood procedure (NP) has been associated with improved survival and decreased adverse events (AE). There is no data describing inferior vena cava saturation (Sivo2) monitoring after NP. We sought to investigate the utility of intermittent Sivo2 monitoring after NP and to assess the correlation of Sivo2 with renal near-infrared spectroscopy (rNIRS). We hypothesized failure to achieve Sivo2 greater than 45% within the first 4 hours after NP is predictive of AE, and that rNIRS correlates with Sivo2. ⋯ Intermittent Sivo2 can be used to guide early postoperative NP management; rNIRS is an accurate continuous, noninvasive surrogate for Sivo2. An Sivo2 of less than 45% in the first 4 hours after the NP is predictive of AE.
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Multicenter Study
Surgical management of neonatal atrioventricular septal defect with aortic arch obstruction.
For neonates with atrioventricular septal defect and aortic arch obstruction including coarctation of the aorta, we sought to determine whether a difference in outcomes exists after a primary neonatal versus staged surgical repair (neonatal arch repair with delayed intracardiac repair). ⋯ For neonates with atrioventricular septal defect and aortic arch obstruction, when compared with neonatal repair, a staged approach was associated with improved survival and lower morbidity.
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Randomized Controlled Trial Comparative Study
Changes in health-related quality of life in off-pump versus on-pump cardiac surgery: Veterans Affairs Randomized On/Off Bypass trial.
The relative benefits of performing coronary artery bypass graft surgery off-pump versus on-pump continue to be debated. A critical, patient-centered outcome is health-related quality of life; yet there has been limited evaluation in large-scale, multicenter trials of the off-pump versus on-pump impact upon quality of life. ⋯ For this trial's male, low-to-moderate risk, veteran population, there were no significant differences between off-pump and on-pump with regard to 1-year general and disease-specific quality of life outcomes. Both treatment arms experienced some improvements by 3 months, with continued improvements through 1-year post-bypass.