The Annals of thoracic surgery
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Empiric experiences suggest higher mortality and complication risk for patients with cirrhosis of the liver after cardiac surgery. However, cirrhosis is not considered a risk factor in either the EuroSCORE or The Society of Thoracic Surgeons score. We report a large single-center experience of patients with cirrhosis undergoing cardiac surgery with extracorporeal circulation and aimed to evaluate the severity of cirrhosis as a predictor of outcome. ⋯ Patients with cirrhosis undergoing heart surgery with extracorporeal circulation have a poor prognosis. Several preoperative factors are related to outcome. EuroSCORE and MELD score may help to evaluate operation risk and indication.
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Comparative Study
Isolated reoperative minimally invasive tricuspid valve operations.
Tricuspid valve (TV) regurgitation has recently been identified as a major risk factor for long-term mortality. Isolated reoperative tricuspid valve repair/replacement (TVR/r) carries an excessively high operative risk. Currently, isolated TVR/r with minimally invasive access through a right lateral thoracotomy is being used increasingly in our institution to treat progressive TV pathologic processes after previous cardiac operations. We analyzed our early and midterm results with reoperative TVR/r in this unique patient cohort. ⋯ Minimally invasive access through a right thoracotomy provides a safe option for reoperative TVR and offers excellent early outcome, particularly in elective cases. Surgical intervention should be performed earlier rather than later.
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Comparative Study
Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer.
Resection of pulmonary colorectal carcinoma metastases may provide long-term benefit, but patient selection remains controversial. The objective of this study was to identify preoperative predictors of survival and lung recurrence for patients undergoing resection of such lesions. ⋯ Older age, male sex, and more lung metastases predict poorer survival after resection of pulmonary colorectal cancer metastases. The number of lung metastases present at the first metastasectomy and the preoperative disease-free interval predicted recurrence in the lung.
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Comparative Study
Perventricular device closure of doubly committed subarterial ventral septal defect through left anterior minithoracotomy on beating hearts.
Surgical repair of doubly committed subarterial ventricular septal defect (VSD) under cardiopulmonary bypass has been the gold standard with full median sternotomy, complicated by skin scarring and potential mortalities and morbidities from cardiopulmonary bypass. Perventricular device closure of muscular and then perimembranous VSD on beating heats with a small subxiphoid or inferior sternotomy has been attempted in the past few years with good results. We have tried perventricular closure of doubly committed subarterial VSD through a left anterior minithoracotomy as an alternative procedure with a modified occluder. ⋯ Selected doubly committed subarterial VSD can be safely closed with a proper occluder through left anterior minithoracotomy. The Cosmetic results are highly satisfactory.
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Comparative Study
Red blood cell transfusion is associated with troponin release after elective off-pump coronary artery bypass surgery.
Increased troponin levels after coronary artery bypass surgery are associated with increased risk of early and late mortality. We hypothesized that perioperative blood transfusion is associated with increased postoperative troponin release. ⋯ Red blood cell transfusion is associated with increased troponin I release after elective off-pump coronary artery bypass graft surgery independently of hemoglobin and hematocrit nadirs. These findings suggest that prevention of major bleeding requiring blood transfusion may be cardioprotective during coronary surgery. Further studies are needed to verify whether troponin release is affected simply by RBC transfusion or by unstable hemodynamic conditions in presence of mild and severe anemia.