J Cardiovasc Surg
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Review Comparative Study
Comparing cost aspects of coronary artery bypass graft surgery with coronary artery stenting.
Randomized trials have compared revascularization of coronary artery disease by coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). CABG is an expensive treatment. However, it manages to improve quality of life, restore general well being, and alleviate symptoms of patients. ⋯ It seems that in longer term, the benefits of CABG may exceed those of stenting and the difference in net cost may be in favour of CABG as the risk of repeat revascularization still increases with PCI regardless of the use of DES. However, to date no long-term data are available in cost-effectiveness between CABG and PCI. The 5-year outcome of the ongoing SYNTAX trial is essential and might therefore provide new insights into the comparison of cost-effectiveness between CABG and DES PCI.
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Identification of patients at high risk for readmission to the Intensive Care Unit (ICU) after cardiac surgery is paramount. We evaluated the clinical characteristics of readmitted patients and identified perioperative prognostic variables for ICU readmission. ⋯ ICU readmission was related to complex surgery and associated with impaired outcome. Respiratory complications were the most common reasons for readmission. Predictive renal and pulmonary risk factors indicate the need of preoperative preconditioning and patient selection.
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Arterial prosthetic graft infection is one of the most challenging issues in vascular surgery. We report a case of an infected descending thoracic aorta endograft, presenting itself several years after placement, with hemoptysis and back pain as referred symptoms. The patient was successfully treated by removing the thoracic aorta and replacing the infected endografts with a cryopreserved aortic allograft, running from the left subclavian artery to the aortic diaphragmatic hiatus.