The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Use of a low-resistance compliant thoracic artificial lung in the pulmonary artery to pulmonary artery configuration.
Thoracic artificial lungs have been proposed as a bridge to transplant in patients with end-stage lung disease. Systemic embolic complications can occur after thoracic artificial lung attachment in the pulmonary artery to left atrium configuration. Therefore, we evaluated the function of a compliant thoracic artificial lung attached via the proximal pulmonary artery to distal main pulmonary artery configuration. ⋯ Use of a compliant thoracic artificial lung may be feasible in the proximal pulmonary artery to distal main pulmonary artery setting if its blood flow is held at less than 75% of cardiac output. To ensure a decrease in cardiac output of less than 10%, a blood flow rate less than 60% of cardiac output is advised.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Does preoperative hyponatremia potentiate the effects of left ventricular dysfunction on mortality after cardiac surgery?
Left ventricular dysfunction and preoperative hyponatremia are associated with adverse outcomes after cardiac surgery. However, the interactions between them are unknown. Thus, we evaluated the interaction of low left ventricular ejection fraction (<40%) and preoperative hyponatremia (Na <135 mEq/L) with morbidity and mortality after cardiac surgery. ⋯ Hyponatremia is more common in patients with low ejection fraction. Although preoperative hyponatremia is independently associated with adverse outcomes in patients with normal ejection fraction, an association with adverse outcomes in patients with low ejection fraction was not demonstrated.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
The natural and unnatural history of the systemic right ventricle in adult survivors.
The study objective was to evaluate long-term trends in morbidity and mortality in a national cohort of adult patients with a systemic right ventricle due to the atrial switch for transposition of the great arteries or congenitally corrected transposition of the great arteries. ⋯ Those patients who survive to adulthood with a systemic right ventricle experience low mortality and good functional status up to 40 years of age. However, there is a substantial burden of atrial tachyarrhythmia, and this occurs significantly earlier in those with transposition of the great arteries-atrial switch. Management of atrial tachyarrhythmia, along with systemic right ventricular dysfunction and systemic atrioventricular valve regurgitation, is likely to be the major challenge for this group of patients over the next decade.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Pulmonary artery interventions after Norwood procedure: does type or position of shunt predict need for intervention?
Pulmonary artery stenosis is a potential complication after Norwood palliation for hypoplastic left heart syndrome. It is unclear whether the shunt type or position in the Norwood procedure is associated with the risk of the development of pulmonary artery stenosis. We examined the risk of pulmonary artery stenosis and the need for pulmonary artery intervention in children undergoing the Norwood procedure with either the right ventricle to pulmonary artery conduit or modified Blalock-Taussig shunt. ⋯ Consistent with a previous multicenter randomized trial, patients who received a right ventricle to pulmonary artery conduit versus a right ventricle to pulmonary artery have a greater risk of requiring pulmonary artery interventions. Patients with right ventricle to pulmonary artery conduit placement to the right underwent a greater number of pulmonary artery interventions but demonstrated overall improved growth of the branch pulmonary arteries compared with the patients receiving a left-sided right ventricle to pulmonary artery conduit.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Diabetes mellitus and the metabolic syndrome do not abolish, but might reduce, the cardioprotective effect of ischemic postconditioning.
Ischemic preconditioning fails to protect the diabetic heart against lethal reperfusion injury. Because the pathways of ischemic pre- and postconditioning partially overlap, we evaluated the cardioprotective effect of ischemic postconditioning in mouse models of type 2 diabetes (ObOb) and the metabolic syndrome (DKO). ⋯ The cardioprotective effect of ischemic postconditioning was sustained in C57BL/6J mice after 10 weeks and protected against adverse left ventricular remodeling. In mouse models of type 2 diabetes, protection against lethal reperfusion injury is present, leading to increased survival after ischemia and reperfusion.