Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2014
ReviewUse of antiplatelet drugs after cardiac operations.
Unfortunately, venous bypass grafts still have a prominent role in operative coronary revascularization (coronary artery bypass graft [CABG]). Venous grafts develop pathologically occlusive disease that limits the effectiveness of CABG, and antiplatelet drugs following operation may limit this problem. ⋯ Evidence suggests that, in most CABG patients, dual antiplatelet drugs (aspirin and clopidogrel), given after operation, minimizes early (within 1 year) graft failure and improves intermediate-term outcomes, better than single antiplatelet therapy with aspirin alone. There are gaps in the knowledge base that supports this contention, and future clinical trials will likely augment or alter this recommendation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2014
Incidence and risk factors for respiratory complications in patients undergoing esophagectomy for malignancy: a NSQIP analysis.
Respiratory complications are the most frequent adverse events in patients undergoing esophagectomy for cancer, and their occurrence may negatively affect postoperative recovery and outcomes. We queried the American College of Surgeons National Surgical Quality Improvement Program dataset to study the rate and influence of pneumonia, unplanned intubation, and ventilator dependency >48 hours on the early outcomes after esophagectomy and risk factors for their development. We included adult patients with an esophageal or gastric cancer diagnosis who were treated with esophagectomy between 2005 and 2012 and grouped them into 2 categories with respect to development of respiratory complications. ⋯ These patients also had statistically significantly higher rates of 30-day mortality and overall morbidity and were more likely to return to the operating room and to stay in the hospital longer. On multivariable analysis, numerous factors, including advanced age, smoking, alcohol use, dyspnea, history of chronic obstructive pulmonary disease, and prolonged operative time, were found to be risk factors for developing respiratory complications. As the development of respiratory complications leads to worse early surgical outcomes after esophagectomy, efforts should be made to prevent their occurrence by identifying patients with significant risk factors.
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Transcatheter aortic valve replacement (TAVR) has been developed as a less-invasive approach to address patients at high risk to extreme risk for surgical aortic valve replacement. The CoreValve US trial enrolled patients with symptomatic severe aortic stenosis into 2 separate cohorts: an extreme-risk cohort and a high-risk cohort. ⋯ The CoreValve high-risk trial is the only randomized trial of TAVR vs surgical aortic valve replacement to show superior survival of TAVR. This was achieved with a numerically lower rate of major stroke and statistically superior changes in aortic valve function from baseline to 1 year.