The Annals of thoracic surgery
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High blood lactate levels during cardiopulmonary bypass (CPB) are associated with tissue hypoperfusion and may contribute to postoperative complications or death. The objective of this study was to determine an association between blood lactate levels during CPB and perioperative morbidity and mortality. ⋯ Blood lactate concentration of 4.0 mmol/L or higher during CPB identifies a subgroup of patients with increased risk of postoperative morbidity and mortality.
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The anatomical definition of N1 stations, its boundary to N2 stations, and its prognostic implication are yet to be defined in lung cancer. Metastasis in lymph nodes close to the pleural reflection has been classified differently as N1 or N2 according to the lymph node maps promulgated so far. ⋯ In terms of prognosis, a pleural reflection does not seem an appropriate anatomical boundary between N1 and N2 stations in lung cancer.
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This report describes technical details of the right thoracotomy approach for mitral surgery, and analyzes our experience with this procedure for patients with a prior sternotomy. Three methods for myocardial management (hypothermic cardioplegic arrest, beating heart, and fibrillating heart) are compared. ⋯ Right thoracotomy provides efficient exposure for reoperative mitral surgery. Mitral valve procedures on the fibrillating or beating heart are feasible in most patients and are at least as safe as surgery using cardioplegic arrest.
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Although minimally invasive surgical procedures have aroused much interest in cardiac surgery, difficulty still exists with its application in most of the operations on great arteries. This report summarizes our initial experience of aortic root replacement by a superior ministernotomy in terms of operative indications, operative techniques, and potential benefits. ⋯ Aortic root replacement by a superior ministernotomy in cardiopulmonary bypass with cannulas through the femoral artery and femoral vein or right atrium is a safe, reliable procedure with excellent exposure. The procedure provides a potential benefit of less trauma, quick recovery, and reduction of mediastinal drainage and reduction of blood transfusion.
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Case Reports
Doppler tissue imaging to predict myocardial recovery during mechanical circulatory support.
Bridge to recovery is a possibility for patients receiving mechanical circulatory support. However, no reliable factors exist to predict a sustained myocardial recovery. We report the use of a new technique of Doppler tissue imaging to document myocardial recovery in two cases with promising results.