The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2008
Comparative StudyThe benefits of early valve replacement in asymptomatic patients with severe aortic stenosis.
The prevalence of aortic valve stenosis increases with age, and often the diagnosis is made by echocardiography before symptoms develop. To address the controversies in management of asymptomatic patients with severe aortic stenosis, we assessed the early and late outcomes of aortic valve replacement in these patients. ⋯ Among patients with severe aortic stenosis who underwent aortic valve replacement, early and late outcomes were similarly good in patients who had symptoms before the operation compared with those who were asymptomatic. It is important to note that among patients with asymptomatic severe aortic stenosis, the omission of surgical treatment was the most important risk factor for late mortality.
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J. Thorac. Cardiovasc. Surg. · Feb 2008
Preoperative statins for the prevention of atrial fibrillation after cardiothoracic surgery.
Recent studies have suggested that statins reduce atrial fibrillation after cardiothoracic surgery, but the use of proven prophylactic strategies such as beta-blockers and amiodarone in these studies was not provided. Therefore, we sought to determine whether preoperative statin use could reduce the incidence of post-cardiothoracic surgery atrial fibrillation in a population who already had a high background use of beta-blockers and appreciable use of prophylactic amiodarone. ⋯ In a population with appreciable beta-blocker and amiodarone use, adjunctive preoperative statin use was still associated with a 40% reduction in patients' odds of developing post-cardiothoracic surgery atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · Feb 2008
Randomized Controlled TrialRandomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery.
We previously reported that postoperative hemodynamics and developmental outcomes were better among infants randomized to a higher hematocrit value during hypothermic cardiopulmonary bypass. However, worse outcomes were concentrated in patients with hematocrit values of 20% or below, and the benefits of hematocrit values higher than 25% were uncertain. ⋯ Hemodilution to hematocrit levels of 35% compared with those of 25% had no major benefits or risks overall among infants undergoing 2-ventricle repair. Developmental outcomes at age 1 year in both randomized groups were below those in the normative population.
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J. Thorac. Cardiovasc. Surg. · Feb 2008
Predictors affecting durability of epicardial pacemaker leads in pediatric patients.
Despite pacemaker therapy in children and adolescents favoring an initial epicardial approach, predictors of lead failure have not been well clarified. The aim of this study was to assess the long-term outcomes and to determine predictors affecting lead durability in pediatric pacing therapy. ⋯ Epicardial leads provide a reliable technique for managing rhythmic disturbance problems in the pediatric population. The only significant predictor of lead failure is the presence of structural heart disease.
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J. Thorac. Cardiovasc. Surg. · Feb 2008
Results of a prospective algorithm to remove chest tubes after pulmonary resection with high output.
Many patients have their hospital discharge delayed because their chest tube drainage is too high, despite the fact that there are no data to support the commonly used 250 mL/day threshold. ⋯ Chest tubes can be removed with up to 450 mL/day of nonchylous drainage after pulmonary resection, and perhaps a higher volume could be accepted. Readmission owing to a recurrent effusion is exceedingly uncommon, and the practice of leaving the tube in longer for drainage less than 450 mL/day is unsupported in the literature.