The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Multicenter StudyOutcomes in adult congenital heart surgery: analysis of the Society of Thoracic Surgeons database.
Outcomes data for adults undergoing congenital heart surgery are limited. Previous analyses used administrative data or focused on single-center outcomes. We describe the most common operations, patient characteristics, and postoperative outcomes using a multicenter clinical database. ⋯ Most adult congenital heart operations listed in the Society of Thoracic Surgeons Congenital Heart Surgery Database are performed in the third to fourth decades of life; approximately half are for right heart pathology or arrhythmia. Many patients have complications, but mortality is low with the exception of those undergoing Fontan revision/conversion. Many more adults undergoing congenital heart surgery are entered into the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Effect of sensitization in US heart transplant recipients bridged with a ventricular assist device: update in a modern cohort.
Preformed anti-human leukocyte antigen antibodies have been associated with prolonged wait times and increased mortality in orthotopic heart transplantation. We used United Network for Organ Sharing data to examine panel reactive antibody titers in patients bridged to transplant with left ventricular assist devices. ⋯ This is the largest modern study to examine the impact of detailed panel reactive antibody information in patients bridged to transplant. High panel reactive antibody levels do not affect drug-treated rejection episodes in the first year post-orthotopic heart transplantation; however, there is an associated higher rate of primary graft dysfunction, regardless of device type. Highly sensitized patients bridged to transplant experience excellent survival outcomes after orthotopic heart transplantation.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Comparative StudyOpen versus endovascular repair for patients with acute traumatic rupture of the thoracic aorta.
The study objective was to compare the outcome between open and endovascular repair of acute traumatic rupture of the thoracic aorta. ⋯ Compared with open repair, endovascular repair of traumatic thoracic aortic rupture is associated with a lower death rate but failed to reach statistical significance, most likely because of underpowering. These results prompt us to consider endovascular repair as the first-line therapy for acute traumatic rupture of the thoracic aorta, except in some rare but challenging anatomic situations. New stent-graft designs, sizes, and deployment systems could improve the results of endovascular repair in these indications.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Comparative StudyEndovascular versus open repair of ruptured descending thoracic aortic aneurysms: a nationwide risk-adjusted study of 923 patients.
Recent studies support the use of endovascular treatment for ruptured abdominal aortic aneurysms, but few studies have examined the use of thoracic endovascular aortic repair (TEVAR) for ruptured descending thoracic aortic aneurysm. We evaluated nationwide data regarding short-term outcomes of TEVAR and open aortic repair (OAR) for ruptured descending thoracic aortic aneurysm. ⋯ Nationwide data for ruptured descending thoracic aortic aneurysm reveal equivalent mortality, complication rates, and failure to rescue for TEVAR and OAR but more frequent routine discharge with TEVAR. Unlike OAR outcomes, TEVAR outcomes were not poorer in smaller hospitals, where TEVAR produced fewer complications than OAR. Therefore, TEVAR may be an ideal alternative to OAR for ruptured descending thoracic aortic aneurysm, particularly in small hospitals where expertise in OAR may be lacking and immediate transfer to a higher echelon of care may not be feasible.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
The impact of low preoperative fat-free body mass on infections and length of stay after cardiac surgery: a prospective cohort study.
Several studies have shown low fat-free mass index to be a stronger predictor for mortality than low body mass index. The main aim of this study was to assess the still unknown association between preoperative low fat-free mass index and adverse cardiac surgical outcomes. ⋯ Low fat-free mass index is associated with increased occurrence of adverse outcomes after cardiac surgery. We advocate fat-free mass index as the leading parameter in classifying and treating undernourished cardiac surgical patients, which might improve recovery rates after cardiac surgery.