The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyAssociation of device surface and biomaterials with immunologic sensitization after mechanical support.
Biomaterials and textured surfaces in early pulsatile left ventricular assist devices (HeartMate I; Thoratec Corporation, Pleasanton, Calif) may increase immunologic risk through allosensitization. We hypothesized that axial-flow devices without biologic membranes or textured surfaces (HeartMate II; Thoratec; and DeBakey; MicroMed Cardiovascular, Inc, Houston, Tex) would cause less allosensitization than devices with such membranes and surfaces. ⋯ Hemodynamic support with HeartMate II and DeBakey devices produced less allosensitization than did HeartMate I devices. Device selection may improve clinical outcomes for high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyExtracorporeal lung membrane provides better lung protection than conventional treatment for severe postpneumonectomy noncardiogenic acute respiratory distress syndrome.
We compared conventional treatment with pumpless extracorporeal lung membrane (Interventional Lung Assist [iLA] Novalung; Novalung GmbH, Hechingen, Germany) support in a pig model of postpneumonectomy severe acute respiratory distress syndrome. ⋯ The pumpless extracorporeal lung membrane and near-static ventilation achieved a significantly better outcome than conventional treatment in this pig model of severe postpneumonectomy acute respiratory distress syndrome, probably because the injured lungs were not forced to work and this "rest" gave them more time to heal.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Randomized Controlled TrialLocal infusion of bupivacaine combined with intravenous patient-controlled analgesia provides better pain relief than intravenous patient-controlled analgesia alone in patients undergoing minimally invasive cardiac surgery.
This prospective randomized double-blind study examined the effect of local wound infusion of anesthetics on pain control in the thoracotomy wound of patients undergoing minimally invasive cardiac surgery. ⋯ In this controlled double-blind study, thoracotomy wound infusion and patient-controlled analgesia were superior to patient-controlled analgesia alone in reducing pain at 1, 3, and 90 days after minimally invasive cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyImproving outcomes with long-term "destination" therapy using left ventricular assist devices.
Destination therapy experience using long-term left ventricular assist devices was analyzed relative to the benchmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial to evaluate the potential for improving outcomes with this groundbreaking therapy for advanced heart failure. ⋯ This analysis provides evidence that long-term destination therapy can be improved well beyond the pioneering experience of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. With continued evolution of devices, management, and patient selection, outcomes approaching those of heart transplantation may be possible.
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J. Thorac. Cardiovasc. Surg. · Jun 2008
Comparative StudyThe "occasional open heart surgeon" revisited.
Case volume in cardiac surgery has been a concern since the term "the occasional open heart surgeon" was used more than 40 years ago, indicating one who performs cardiac surgery infrequently. ⋯ A high-volume surgeon becomes an "occasional open heart surgeon" when working at multiple hospitals and performing a small volume of procedures at some of them. This study suggests that volume is not as important as processes of care in determining outcomes of coronary artery bypass grafting procedures and that system factors might be more important to outcomes than surgeon experience.