Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
The Effect of Preoperative Anemia on Patients Undergoing Cardiac Surgery: A Propensity-Matched Analysis.
It is unknown if anemia in the absence of transfusions is an independent risk factor for adverse outcomes in cardiac surgery, and if correction to higher hemoglobin targets impacts these outcomes. This is a retrospective review of 3848 cardiac surgery patients. Propensity matching was completed using 41 covariates. ⋯ There was a significant increase in low cardiac output in the lower threshold group (P = 0.001). There were no differences in outcomes between those who did and did not receive postoperative transfusions (P > 0.05). Preoperative anemia in the absence of transfusions is a risk factor for morbidity and mortality after cardiac surgery, and there is no evidence that transfusion to higher end cardiopulmonary bypass hemoglobin levels impacted this risk.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2019
Complete Thoracic Aorta Remodeling After Endovascular Aortic Repair: A New Therapeutic Goal for Chronic DeBakey IIIb Aneurysms.
To introduce complete thoracic aorta remodeling as a new therapeutic target of thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms, and analyze the predictors for complete thoracic aorta remodeling. From 2012 to 2017, 75 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms. Complete thoracic aorta remodeling was defined as thoracic false lumen thrombosis with false lumen diameter <5 mm down to T-10 level. ⋯ The number of visceral branches from the false lumen and residual intima tears were significant risk factors for complete thoracic aorta remodeling (HR 0.627, p = 0.041 and HR 0.754, p = 0.042). In chronic DeBakey IIIb aneurysms, complete thoracic aorta remodeling may be the ideal target for endovascular treatment rather than false lumen thrombosis. Additional procedures to eliminate the obstacles to complete thoracic aorta remodeling (number of visceral branches from the false lumen and residual intimal tears) and close follow-up after thoracic false lumen thrombosis may be needed to achieve the optimal outcome.