The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Editorial ReviewSystematic review of outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection.
Available data on outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection are limited. This is a systematic review of outcomes of this approach. ⋯ Combined proximal stent grafting with distal bare stenting for management of aortic dissection appears to be a reasonable approach for type B aortic dissection, clearly improved true-lumen perfusion and diameter although failing to suppress false-lumen patency completely. Contemporary information on this approach is mainly provided by small series with a wide range of results.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Randomized Controlled TrialAntifibrinolytics attenuate inflammatory gene expression after cardiac surgery.
Anti-inflammatory effects of tranexamic acid and aprotinin, used to abate perioperative blood loss, are reported and might be of substantial clinical relevance. The study of messenger ribonucleic acid synthesis provides a valuable asset in evaluating the inflammatory pathways involved. ⋯ This study demonstrates that the use of tranexamic acid and aprotinin results in altered inflammatory pathways on the genomic expression level. We further demonstrate that the use of aprotinin leads to significant attenuation of the immune response, with several inhibitory effects restricted to the use of aprotinin only. The results aid in a better understanding of the targets of these drugs, and add to the discussion on which antifibrinolytic can best be used in the cardiac surgical patient.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Predictors of conversion to thoracotomy for video-assisted thoracoscopic lobectomy: a retrospective analysis and the influence of computed tomography-based calcification assessment.
Conversion to an open thoracotomy during video-assisted thoracoscopic surgery lobectomy is reported to occur in up to 23% of cases and can be associated with increased morbidity. We developed a preoperative computed tomography calcification score based on anatomic location and extent of calcifications to evaluate the ability to predict video-assisted thoracoscopic surgery conversion. ⋯ Calcification score based on the location and degree of calcifications can predict the increased likelihood of video-assisted thoracoscopic surgery conversion. This scoring system could be one element used to choose the approach for a lobectomy, especially during a surgeon's learning curve.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Clinical impact of neurocognitive deficits after cardiac surgery.
Postoperative neurocognitive deficits (POCDs) have been found to occur frequently after cardiac surgery. Although POCDs have received significant attention in the medical literature and public media, the true clinical impact of these deficits on patient outcomes and quality of life (QOL) is not well defined. ⋯ Neurocognitive deficits can be frequently detected on comprehensive neuropsychometric testing after cardiac surgery. However, they are not associated with any clinically important differences in patient outcome or in QOL after surgery.