The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2012
Randomized Controlled TrialTriiodothyronine supplementation and cytokines during cardiopulmonary bypass in infants and children.
The Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC) study demonstrated a shortened time to extubation in children younger than 5 months old undergoing cardiopulmonary bypass for congenital heart surgery with triiodothyronine supplementation. Cardiopulmonary bypass precipitates a systemic inflammatory response that affects recovery, and triiodothyronine is related to cytokine mediators of inflammation. We sought to investigate the preoperative cytokine levels by age and relationship to the triiodothyronine levels and to examine the effect of the cytokine levels on the time to extubation. ⋯ The preoperative and postoperative cytokine levels, in particular, interleukin-1β, showed complex time-dependent relationships with triiodothyronine. The data suggest that cytokine-mediated suppression of triiodothyronine plays an important role in determining the clinical outcome after cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
When the timing is right: Antibiotic timing and infection after cardiac surgery.
Guidelines recommend antibiotic prophylaxis 60 minutes before skin incision; however, it is unclear whether more precise timing would further reduce sternal wound infection. Our objectives were to examine the relationship between antibiotic timing and infection, test potential efficacy of optimal antibiotic timing in preventing infection, and determine whether patient comorbidity is related to timing and infection. ⋯ Refining current antibiotic prophylaxis guidelines may lower sternal wound infections. Antibiotic administration timing resulting in lowest likelihood for infection varied with antibiotic and patient-specific factors. Optimal risk-adjusted timing could potentially reduce infections by 9%-31%.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
Reconstruction of pulmonary artery with porcine small intestinal submucosa in a lamb surgical model: Viability and growth potential.
This study investigated the time-dependent remodeling and growth potential of porcine small intestine submucosa as a biomaterial for the reconstruction of pulmonary arteries in a lamb model. ⋯ Our data confirmed that remodeling and growth potential of the small intestine submucosal biomaterial are time dependent. Additional experiments are required to investigate the stability of the patch material over a longer period.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
A new classification of bronchial anastomosis after sleeve lobectomy.
Ischemia and infection of the distal part of the tracheobronchial anastomosis are the leading causes of bronchial anastomotic leakage with a high morbidity and mortality. To improve interpretation of healing of the anastomosis and the consequences, we have developed a classification scheme that allows quality control and defines early and standardized treatment of complications. ⋯ Quality control of the tracheobronchial anastomosis comprised bronchoscopy performed before patients were dismissed. Inasmuch as postoperative bronchoscopy is not always performed by the operating surgeon, this classification is an aid to improve the description of endobronchial healing and to commence treatment of critical bronchial healing.