The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Randomized Controlled Trial Comparative StudyA randomized comparison of the Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft (SAVE RITA) trial: early results.
The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft trial was designed to evaluate the saphenous vein compared with the right internal thoracic artery as a Y-composite graft anastomosed to the side of the left internal thoracic artery. In this early analysis, we compared early angiographic patency rates and clinical outcomes. ⋯ A third conduit was needed to extend the right internal thoracic artery composite graft and reach the target vessels in 36.4% (40/110) of the patients. The saphenous vein composite graft was comparable with the right internal thoracic artery composite graft in terms of early angiographic patency and clinical outcomes.
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In 2008, we saw the withdrawal of aprotinin from the US markets after preliminary results from a large, randomized clinical trial in Canada. This drug, a potent antifibrinolytic, was used primarily in complex and/or redo cardiac surgery as an adjunct to decrease postoperative bleeding and complications. The Canadian study raised questions previously brought up in similar studies-does aprotinin increase the risk of mortality and renal failure after cardiac surgery? Recently, a re-review of the Canadian data noted flaws in the study, as well as in the interpretation of the results. The present review revisits the aprotinin controversy.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Randomized Controlled Trial Comparative StudyAmiodarone versus lidocaine and placebo for the prevention of ventricular fibrillation after aortic crossclamping: a randomized, double-blind, placebo-controlled trial.
Ventricular fibrillation occurs commonly after aortic crossclamping in patients undergoing cardiac surgery. Ventricular fibrillation increases myocardial oxygen consumption, and defibrillation may harm the myocardium. Thus, a pharmacologic approach to decreasing the incidence of ventricular fibrillation or the number of shocks required may be beneficial. The goal of this study was to evaluate whether amiodarone or lidocaine was superior to placebo for the prevention of ventricular fibrillation after aortic crossclamping in patients undergoing a variety of cardiac surgical procedures. ⋯ In patients undergoing a variety of cardiac surgical procedures, neither amiodarone nor lidocaine reduced the incidence of ventricular fibrillation. Amiodarone decreased the number of shocks required to terminate ventricular fibrillation.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Multicenter StudyAortic valve replacement in neonates and infants: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
We sought to describe early outcomes of aortic valve replacement in neonates and infants across a large multicenter cohort. ⋯ Neonates and infants undergoing aortic valve replacement are a high-risk group, with hospital mortality comparable with some of the highest risk procedures in this age group. The requirement for arch repair or postoperative mechanical circulatory support was associated with an increased risk of death in this cohort.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Survival and quality of life at least 1 year after pneumonectomy.
Quality of life after pulmonary resection is becoming an increasingly important part of the conversation between patients and surgeons. Pneumonectomy is often called a disease. The objective of this study was to assess the physical and mental aspects of patients' quality of life at least 1 year after pneumonectomy. ⋯ Pneumonectomy is tolerated in carefully selected patients. The physical quality-of-life score 1 year after resection is significantly lower than the average population, yet the mental score in these patients is higher. Future studies on quality of life should be considered for all medical therapies, and stratification of the mental score from the physical score should be reported.