The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2011
Late improvement in graft patency after coronary artery bypass grafting: Serial assessment with multidetector computed tomography in the early and late postoperative settings.
Grafts initially showing poor patency after coronary artery bypass grafting have occasionally shown improvement on serial multidetector computed tomography. This study analyzed possible factors associated with this phenomenon. ⋯ A large proportion of radial artery grafts initially showing poor opacification after coronary artery bypass grafting demonstrated patency restoration on serial multidetector computed tomography. Larger target vessel size and target vessel stenosis of at least 90% were significant correlative factors.
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J. Thorac. Cardiovasc. Surg. · Oct 2011
Initial consecutive experience of completely portal robotic pulmonary resection with 4 arms.
Many general thoracic surgeons are learning robotic pulmonary resection. ⋯ The newly refined CPRL-4 is safe and yields an R0 resection with complete lymph node removal. It has lower morbidity, mortality, shorter hospital stay, and better quality of life than rib- and nerve-sparing thoracotomy. Technical advances are possible to shorten and improve the operation.
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J. Thorac. Cardiovasc. Surg. · Oct 2011
Comparative StudyPrognostic implications of pulmonary hypertension in patients with severe aortic stenosis.
We sought to determine the clinical outcomes of patients undergoing surgical aortic valve replacement with hemodynamically confirmed severe pulmonary hypertension and aortic stenosis and compare them with the outcomes of patients not undergoing aortic valve replacement and patients undergoing aortic valve replacement with mild-to-moderate pulmonary hypertension. ⋯ In patients with severe aortic stenosis and severe pulmonary hypertension who undergo aortic valve replacement, baseline pulmonary artery pressure does not unfavorably affect survival. Aortic valve replacement should be considered for patients with aortic stenosis with severe pulmonary hypertension, especially with higher pulmonary capillary wedge pressure.
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J. Thorac. Cardiovasc. Surg. · Oct 2011
New approach to interstage care for palliated high-risk patients with congenital heart disease.
Home surveillance monitoring might identify patients at risk for interstage death after stage 1 palliation for hypoplastic left heart syndrome. We sought to identify the effect that a high-risk program might have on interstage mortality and identification of residual/recurrent lesions after neonatal palliative operations. ⋯ Initiation of a high-risk program might decrease interstage mortality after high-risk neonatal palliative operations. Such an approach might contribute to earlier detection of significant residual/recurrent lesions amenable to therapy.
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J. Thorac. Cardiovasc. Surg. · Oct 2011
Impact of prior hospital mortality versus surgical volume on mortality following surgery for congenital heart disease.
Our objective was to assess the relationships of a hospital's past adjusted in-hospital mortality and surgical volume with future in-hospital mortality after surgery for congenital heart disease. ⋯ In this data set, prior hospital surgical volume tended to be associated with improved mortality after higher-risk operations in pediatric patients with congenital heart disease, whereas prior hospital postoperative mortality was significantly associated with mortality across all risk strata of congenital heart surgery.