The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Conservative management of postoperative bronchopleural fistulas.
A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery. ⋯ BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Clinical outcomes of aortic root replacement after previous aortic root replacement.
The study objective was to examine the short- and long-term outcomes of reoperative aortic root replacement after a previous aortic root replacement. ⋯ Aortic root replacement after a previous aortic root replacement is associated with a relatively low operative mortality and perioperative morbidity, but long-term survival is suboptimal. Increasing age and prosthetic valve endocarditis adversely affect survival.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Contemporary experience with surgical treatment of aortic valve disease in children.
Surgical treatment of aortic valve (AoV) disease in childhood involves complex decisions particularly in very small patients. There is no consensus regarding the optimum surgical option. The objective of this review was to analyze a contemporary experience of AoV surgery in a large children's hospital. ⋯ AoV repairs and replacements were generally found to be associated with low death and reoperation rates at long-term follow-up. Infants had a lower freedom from reintervention or death after either an AoV repair or replacement, although truncal valve repairs and AoV replacement in patients with concomitant CHD were associated with lower valve survival. Among the valve options, homograft root replacement had a higher risk of death/reoperation and lowest freedom from reintervention or death.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Cold agglutinins in patients undergoing cardiac surgery requiring cardiopulmonary bypass.
Cold agglutinins (CA) are circulating autoantibodies present in most humans. They are active below normal body temperatures. Cold hemagglutinin disease involves the presence of CA sufficiently active at temperatures in the periphery to produce hemolysis or agglutination. Systemic hypothermia and cold cardioplegia may result in agglutination or hemolysis. We reviewed the experience of a large referral center in managing patients with CA and cold hemagglutinin disease undergoing cardiac surgery requiring cardiopulmonary bypass. ⋯ All patients with CA/cold hemagglutinin disease at the Mayo Clinic College of Medicine safely underwent cardiac surgery without major adverse morbidity or mortality. Patients with CA but without evidence of cold hemagglutinin disease can safely undergo normothermic cardiopulmonary bypass at 37°C and warm cardioplegia without further testing. Patients with cold hemagglutinin disease should undergo laboratory testing including CA titers and thermal amplitude and hematology consultation before cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Ischemic postconditioning protects the spinal cord from ischemia-reperfusion injury via modulation of redox signaling.
It is well known that ischemic postconditioning reduces ischemic-reperfusion injury, but the underlying mechanism is not fully understood. The current study investigated the role of reactive oxygen species-mediated upregulation of endogenous antioxidant enzymes in the generation of a protective effect induced by ischemic postconditioning against spinal cord reperfusion injury in the rabbit. ⋯ The results indicate that reactive oxygen species-triggered upregulation of endogenous antioxidant enzyme activities may be involved in the mechanism of neuroprotection of ischemic postconditioning.