The Annals of thoracic surgery
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Surgical treatment of mitral stenosis with extreme calcification remains a challenge. Recently, the balloon-expandable valve prosthesis, anchored by radial force, offers a new option for these patients. We present 2 cases of transcatheter mitral valve replacement in patients with severe native mitral valve stenosis and annular calcification deemed too extensive for conventional surgical techniques.
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Randomized Controlled Trial
A Randomized Controlled Trial of High-Flow Nasal Oxygen (Optiflow) as Part of an Enhanced Recovery Program After Lung Resection Surgery.
Patients undergoing thoracic surgery are at risk of postoperative pulmonary complications, which are associated with increased morbidity and mortality. High-flow nasal oxygen therapy delivers humidified, warmed positive airway pressure but has not been tested routinely after thoracic surgery. ⋯ Prophylactic high-flow nasal oxygen therapy, when incorporated into an enhanced recovery program, did not improve 6-minute walk test results but was associated with reduced length of hospital stay and improved satisfaction after lung resection, compared with standard oxygen. This finding has implications for reduced costs and better service provision, and a multicenter trial powered for length of stay is required.
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Current guidelines for gastrointestinal cancer surgical intervention in high-risk patients recommend postoperative venous thromboembolism (VTE) chemical prophylaxis for 4 weeks with low-dose unfractionated heparin or low-molecular-weight heparin, but specific guidelines for esophagectomy are lacking. This survey identified the clinical patterns affecting postesophagectomy VTE chemoprophylaxis use among general thoracic surgeons. ⋯ Thoracic surgeons agree that VTE chemoprophylaxis is necessary for esophagectomy, yet substantial variability exists in current practice. A noteworthy proportion use suboptimal dosing, and very few choose postdischarge prophylaxis. To improve postesophagectomy morbidity and mortality outcomes, thoracic surgeons are willing to follow evidence-based guidelines for VTE chemoprophylaxis.
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Randomized Controlled Trial
Effect of a Single Bolus of Erythropoietin on Renoprotection in Patients Undergoing Thoracic Aortic Surgery With Moderate Hypothermic Circulatory Arrest.
Acute kidney injury (AKI) is associated with high morbidity and mortality. Recombinant human erythropoietin has been shown to exert cytoprotection against ischemia. This study examined the effect of erythropoietin in preventing AKI during thoracic aortic surgery with moderate hypothermic circulatory arrest. ⋯ A single bolus administration of erythropoietin 500 IU·kg(-1) at anesthesia induction failed to provide renoprotection in patients who underwent thoracic aortic surgery with moderate hypothermic circulatory arrest. However, erythropoietin significantly reduced cardiac complications, and lowered the incidence of prolonged vasopressor dependence.
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Transcatheter aortic valves may develop structural valve deterioration. With that development the issue arises of repeated transcatheter aortic valve insertion. There are, unfortunately, limited data about repeated transapical valve insertion, with only a single case report in the literature. We report an additional successful case.