The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Cardiac surgery in adults performed at children's hospitals: trends and outcomes.
The number of adults with congenital heart disease who require cardiac surgery is projected to increase dramatically. Controversy exists as to whether such procedures should be performed in pediatric centers, which generally have the greatest experience with operations for congenital heart disease. We sought to report the outcomes for cardiac surgery performed in adults (>or=21 years of age) at children's hospitals and determine how these practices varied among institutions. ⋯ A significant number of adult cardiac surgical procedures are being performed at children's hospitals with excellent results. The majority of procedures are not related to complex shunt lesions but rather pacemaker/defibrillator implantation and semilunar valve surgery. Whether adult patients with congenital heart disease should continue to undergo most cardiac surgery in children's hospitals is worthy of discussion.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Comparative StudyUse of mathematic modeling to compare and predict hemodynamic effects of the modified Blalock-Taussig and right ventricle-pulmonary artery shunts for hypoplastic left heart syndrome.
Stage one reconstruction (Norwood operation) for hypoplastic left heart syndrome can be performed with either a modified Blalock-Taussig shunt or a right ventricle-pulmonary artery shunt. Both methods have certain inherent characteristics. It is postulated that mathematic modeling could help elucidate these differences. ⋯ The close correlation between predicted and observed data supports the use of mathematic modeling in the design and assessment of surgical procedures. The potentially damaging effects of a systemic ventriculotomy in the right ventricle-pulmonary artery shunt modification of the Norwood operation have not been analyzed.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients.
Treatment of central and paracentral pulmonary embolism in patients with hemodynamic compromise remains a subject of debate, and no consensus exists regarding the best method: thrombolytic agents, catheter-based thrombus aspiration or fragmentation, or surgical embolectomy. We reviewed our experience with emergency surgical pulmonary embolectomy. ⋯ Surgical pulmonary embolectomy is an excellent option for patients with major pulmonary embolism and can be performed with minimal mortality and morbidity. Even patients who present with cardiac arrest and require preoperative cardiopulmonary resuscitation show satisfying results. Immediate surgical desobstruction favorably influences the pulmonary pressure and the recovery of right ventricular function, and remains the treatment of choice for patients with massive central and paracentral embolism with hemodynamic and respiratory compromise.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Quality improvement program decreases mortality after cardiac surgery.
This study investigated the effects of a quality improvement program and goal-oriented, multidisciplinary protocols on mortality after cardiac surgery. ⋯ Application of goal-directed, multidisciplinary protocols and a quality improvement program were associated with lower mortality after cardiac surgery. This decline was less prominent in patients with diabetes, and focused quality improvement protocols may be required for this subset of patients.
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J. Thorac. Cardiovasc. Surg. · Aug 2008
Randomized Controlled TrialA prospective randomized trial comparing completion technique of fissures for lobectomy: stapler versus precision dissection and sealant.
Alveolar air leaks are common after pulmonary resection, often prolonging hospitalization and increasing surgical morbidity and costs. Air leakages result from lung tissue traumatized by the dissection of fissures. This randomized and controlled trial evaluates 2 different surgical techniques for the completion of interlobar fissures during pulmonary lobectomy to establish which is superior in preventing air leakage. ⋯ The use of electrocautery dissection and collagen patches coated with human fibrinogen and thrombin (TachoSil, Nycomed, Vienna, Austria) for aerostasis to complete interlobar fissures seems to be safe and effective in reducing alveolar air leaks and procedure costs. Although this pilot study showed advantages in terms of hospitalization and cost benefits, further multicentric studies are required to clarify that these differences are statistically significant.