The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2011
Extracorporeal membrane oxygenation support after the Fontan operation.
Extracorporeal membrane oxygenation has been used to support children with cardiac failure after the Fontan operation. Mortality is high, and causes of mortality remain unclear. We evaluated the in-hospital mortality and factors associated with mortality in these patients. ⋯ Cardiac failure requiring extracorporeal membrane oxygenation after the Fontan operation is associated with high mortality. Complications during extracorporeal membrane oxygenation support increase mortality odds. Prompt correction of surgical bleeding when possible may improve survival.
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J. Thorac. Cardiovasc. Surg. · Sep 2011
Lobectomy leads to optimal survival in early-stage small cell lung cancer: a retrospective analysis.
Stage I or II small cell lung cancer is rare. We evaluated the contemporary incidence of early-stage small cell lung cancer and defined its optimal local therapy. ⋯ Surgery is an underused modality in the management of early-stage small cell lung cancer. Lobectomy provides optimal local control and leads to superior survival. Although sublobar resection proved inferior to lobectomy, it conferred a survival advantage superior to radiotherapy alone. The addition of radiotherapy to resection provided no additional benefit.
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J. Thorac. Cardiovasc. Surg. · Sep 2011
Interstage attrition between bidirectional Glenn and Fontan palliation in children with hypoplastic left heart syndrome.
With improving operative mortality for staged palliation of hypoplastic left heart syndrome, interstage death accounts for an increasing proportion of hypoplastic left heart syndrome mortality. We investigated risk factors for death or cardiac transplantation during the interstage period between bidirectional Glenn and Fontan procedures in children with hypoplastic left heart syndrome. ⋯ Interstage attrition between bidirectional Glenn and Fontan procedures occurred in 12% of our study population. Moderate or greater tricuspid valve regurgitation and low weight z score at the time of bidirectional Glenn are important risk factors for interstage attrition between the bidirectional Glenn and Fontan procedures in children with hypoplastic left heart syndrome.
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J. Thorac. Cardiovasc. Surg. · Sep 2011
Should the proximal arch be routinely replaced in patients with bicuspid aortic valve disease and ascending aortic aneurysm?
Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting. ⋯ Progressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.
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J. Thorac. Cardiovasc. Surg. · Sep 2011
Emergency operation for penetrating thoracic trauma in a metropolitan surgical service in South Africa.
This audit examines our total experience with penetrating thoracic trauma. It reviews all the patients who were brought alive to our surgical service and all who were taken directly to the mortuary. The group of patients who underwent emergency operation for penetrating thoracic trauma is examined in detail. ⋯ Penetrating thoracic trauma has a high mortality rate of 30% for subjects with stab wounds and 52% for those with gunshot wounds. Less than a quarter of patients with a penetrating cardiac injury reach the hospital alive. Of those who do and who are operated on, about 90 percent will survive. Other injuries necessitating emergency operation are lung parenchyma, intercostal vessels and internal thoracic vessels, and great vessels of the thorax. Gunshot wounds of the thorax remain more lethal than stab wounds.