The Journal of thoracic and cardiovascular surgery
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To review the current state of clinical practice and discuss recent advances in the diagnosis and management of acute kidney injury (AKI) in the context of cardiac surgery. ⋯ In 2011, the field of AKI could be emerging from a period of stagnation that has lasted more than 2 decades. The failure to translate successful animal model interventions to the clinic might have resulted from delays in diagnosis that might now be avoidable with the advent of novel diagnostic biomarkers.
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J. Thorac. Cardiovasc. Surg. · Mar 2012
Younger gestational age is associated with worse neurodevelopmental outcomes after cardiac surgery in infancy.
Evaluate the impact of near-term delivery on neurodevelopmental (ND) outcomes in children with congenital heart disease (CHD). ⋯ These findings are consistent with the hypothesis that delivery before 39 to 40 weeks of GA is associated with worse outcomes in patients with CHD. Early delivery of a child with CHD is often indicated because of maternal or fetal health issues. In the absence of these concerns, these data suggest that elective (or spontaneous) delivery at 39 to 40 weeks of GA is associated with better ND outcomes.
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J. Thorac. Cardiovasc. Surg. · Mar 2012
Utility of endobronchial ultrasound-guided mediastinal lymph node biopsy in patients with non-small cell lung cancer.
Invasive mediastinal biopsy is often necessary in the evaluation of non-small cell lung cancer (NSCLC), and mediastinoscopy has long been considered the reference standard. However, the emergence of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has resulted in controversy regarding it represents a suitable replacement for mediastinoscopy. We chose to determine the utility of EBUS-TBNA in evaluating the mediastinum in patients with NSCLC. ⋯ EBUS-TBNA might be a feasible option for most patients with NSCLC for whom histologic assessment of the mediastinum is necessary. The rates of nondiagnostic and false-negative biopsy findings using EBUS-TBNA were low, small subcentimeter nodes could be routinely biopsied, and most patients with a radiographically positive mediastinum had their disease pathologically confirmed.
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J. Thorac. Cardiovasc. Surg. · Mar 2012
Multicenter Study Comparative StudyComparative analysis of antifibrinolytic medications in pediatric heart surgery.
Recent studies suggest adverse events associated with aprotinin in adults may not occur in children, and there is interest in further pediatric study of aprotinin. However, there are limited contemporary data comparing aprotinin with other available antifibrinolytics (aminocaproic acid [ACA] and tranexamic acid [TXA]) to guide current practice and aid in potential trial design. We performed a comparative analysis in a large multicenter cohort. ⋯ These observational data suggest aprotinin is associated with reduced bleeding and mortality in children undergoing heart surgery with no increase in dialysis. Comparative analyses suggest similar efficacy of ACA and improved outcomes associated with TXA.
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J. Thorac. Cardiovasc. Surg. · Mar 2012
Fungal infections and antifungal prophylaxis in pediatric cardiac extracorporeal life support.
Infections acquired by children during extracorporeal membrane oxygenation (ECMO) increase mortality. Our aim was to evaluate the effectiveness of prophylactic fluconazole on the incidence of fungal infections and to assess whether hospital-acquired fungal infection is associated with increased in-hospital mortality in pediatric cardiac patients requiring ECMO. ⋯ Children with cardiac disease supported with ECMO who acquire fungal infections have increased mortality. Routine fluconazole prophylaxis is associated with lower rates of fungal infections in these patients.