The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2008
Optimal timing of coronary artery bypass after acute myocardial infarction: a review of California discharge data.
The optimal timing for coronary artery bypass grafting after acute myocardial infarction is not well established. The California Discharge Database facilitates the study of this issue by providing data from a large patient cohort free of institutional bias. We examine the timing of coronary artery bypass grafting after acute myocardial infarction on short-term outcomes. ⋯ Patients undergoing coronary artery bypass grafting within 2 days of hospitalization for acute myocardial infarction experienced higher mortality rates than those undergoing coronary artery bypass grafting 3 or more days after acute myocardial infarction, independently of clinical acuity. This suggests that coronary artery bypass grafting may best be deferred for 3 or more days after admission for acute myocardial infarction in nonurgent cases.
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J. Thorac. Cardiovasc. Surg. · Mar 2008
Comparative StudyCardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database.
The evaluation of operative mortality risk for cardiac surgery in infants with low weight is limited. To determine whether low weight is a risk factor for increased mortality, we reviewed the experience within the Society of Thoracic Surgeons Congenital Heart Surgery Database of infants who have undergone surgical correction or palliation for congenital heart disease. ⋯ Low weight at the time of surgical intervention is associated with increased mortality in patients undergoing several types of cardiovascular procedures. These data do not allow assessment of specific risks or benefits of any particular treatment strategy. However, they do support the need for prospective analysis of specific treatment strategies for these high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Mar 2008
Thoracoscopic lobectomy: report on safety, discharge independence, pain, and chemotherapy tolerance.
Controversies regarding the safety, morbidity, and mortality of thoracoscopic lobectomy have prevented the widespread acceptance of the procedure. This series analyzed the safety, pain, analgesic use, and discharge disposition in patients who underwent thoracoscopic lobectomy and segmentectomy at a single institution. ⋯ Thoracoscopic (video-assisted thoracic surgery) lobectomy can be performed safely. Discharge independence and low pain estimates in the early postoperative period suggest that this approach may be beneficial. Furthermore, there is a trend toward improved tolerance of chemotherapy.
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J. Thorac. Cardiovasc. Surg. · Mar 2008
Aprotinin confers neuroprotection by reducing excitotoxic cell death.
Aprotinin is used in cardiac surgery for its anti-inflammatory and hemostatic benefits. Recent reports describe the neuroprotective effects of other serine protease inhibitors via reduced excitotoxic cell death, a common pathway causing cytotoxic edema induced in various neuropathologic conditions. The purpose of this study was to investigate whether aprotinin directly protects against glutamatergic excitotoxicity in cell cultures. ⋯ Aprotinin provides direct neuroprotection against glutamatergic excitotoxicity as demonstrated by reduced neuronal death in near-pure neuronal cell culture. Additional studies are needed to evaluate the potential of aprotinin to reduce neurologic injury in patients at high risk of cerebral injury, including those undergoing circulatory arrest.