The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2013
Efficacy of extracorporeal membrane oxygenation as a bridge to lung transplantation.
Preoperative extracorporeal membrane oxygenation (ECMO) is a risk factor for poor outcome and currently considered a contraindication to lung transplantation. The lung allocation score system was introduced in May 2005 and prioritizes lung allocation to those with the greatest respiratory impairment. The purpose of this study is to determine whether ECMO as a bridge to lung transplantation is an acceptable option to support those in respiratory failure until donor lungs become available in the lung allocation score era. ⋯ Although the incidence of primary graft dysfunction requiring post-transplant ECMO is higher and the hospital stay is longer in patients receiving pretransplant ECMO, the graft survival is good (2-year survival, 74%). ECMO is efficacious as a bridge to lung transplantation with good post-lung transplant outcomes.
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J. Thorac. Cardiovasc. Surg. · Apr 2013
Elevated messenger RNA expression and plasma protein levels of osteopontin and matrix metalloproteinase types 2 and 9 in patients with ascending aortic aneurysms.
Ascending aortic aneurysms result from a degenerative process in the aortic wall, characterized by the loss of smooth muscle cells and elastic fibers. We hypothesized that there would be changes in plasma protein and aortic tissue messenger RNA levels of osteopontin, matrix metalloproteinase type 2, matrix metalloproteinase type 9, and tissue inhibitor of matrix metalloproteinases type 1 in ascending aortic aneurysm samples. ⋯ This study reveals an important role of osteopontin, MMP-2 and MMP-9 in the development of ascending and abdominal aortic aneurysm.
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J. Thorac. Cardiovasc. Surg. · Apr 2013
An empirically based tool for analyzing morbidity associated with operations for congenital heart disease.
Congenital heart surgery outcomes analysis requires reliable methods of estimating the risk of adverse outcomes. Contemporary methods focus primarily on mortality or rely on expert opinion to estimate morbidity associated with different procedures. We created an objective, empirically based index that reflects statistically estimated risk of morbidity by procedure. ⋯ Complication rates and postoperative length of stay provide related but not redundant information about morbidity. The Morbidity Scores and Categories provide an objective assessment of risk associated with operations for congenital heart disease, which should facilitate comparison of outcomes across cohorts with differing case mixes.
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J. Thorac. Cardiovasc. Surg. · Apr 2013
Effect of atherothrombotic aorta on outcomes of total aortic arch replacement.
The effect of an atherothrombotic aorta on the short- and long-term outcomes of total aortic arch replacement, including postoperative neurologic deficits, remains unknown. We evaluated this relationship and also elucidated the synergistic effect of multiple other risk factors, in addition to an atherothrombotic aorta, on the neurologic outcome. ⋯ Patients with an atherothrombotic aorta and associated preoperative comorbidities might be predisposed to adverse short- and long-term outcomes, including transient neurologic deficits.
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J. Thorac. Cardiovasc. Surg. · Apr 2013
Neoplastic severe central airways obstruction, interventional bronchoscopy: a decision-making analysis.
Cancer can involve the airways, causing various degrees of obstruction. Usually, after days or months of mild to moderate undervalued symptoms, severe dyspnea arises abruptly, imposing an immediate attempt to restore the airflow regardless of the etiology. This study focuses on the development of a predictive preintervention model that is useful when deciding whether to perform therapeutic interventional bronchoscopy in patients with severe central airway obstruction. ⋯ Endoscopic characteristics and location of the neoplastic lesions are the major determinants of patients' endoscopic outcome. The preintervention model adds to the clinical evaluation an important contribution to the decision-making process on performing therapeutic interventional bronchoscopy in a critical setting.