The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyFewer complications result from a video-assisted approach to anatomic resection of clinical stage I lung cancer.
Anatomic resection is currently the standard of care for clinical stage I lung cancer, yet clinicians increasingly pursue nonsurgical, ablative therapies to avoid the morbidity of thoracotomy. The video-assisted thoracic surgery (VATS) approach is a minimally invasive alternative to thoracotomy yet the effect of VATS on the morbidity of patients undergoing lung cancer resection is not fully characterized. We evaluated complications following anatomic resection of clinical stage I lung cancer by VATS and thoracotomy to clarify the effect of the minimally invasive approach. ⋯ Anatomic resection of early stage lung cancer is performed with a low mortality rate, according to data from the Society of Thoracic Surgeons database. Perioperative complications are significantly less likely to occur when patients with stage I lung cancers undergo resection using the VATS approach. Further study is warranted to determine long-term effects of these differences in perioperative outcomes.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Early postoperative bleeding is independently associated with increased surgical mortality in infants after cardiopulmonary bypass.
Infants undergoing cardiac surgery often have postoperative bleeding contributing to the occurrence of adverse events. A quantitative evaluation of postoperative bleeding has not been well described. ⋯ Early postoperative hemorrhage was independently associated with an increased mortality in infants after cardiac surgery. The longer interval from surgery to death suggests that other factors, aside from the bleeding itself, including the transfusion volume, might contribute to mortality. Initiatives to limit postoperative bleeding and to critically appraise packed red blood cell transfusion practices are warranted.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyRestrictive mitral valve annuloplasty versus mitral valve replacement for functional ischemic mitral regurgitation: an exercise echocardiographic study.
Mitral valve annuloplasty and mitral valve replacement are common strategies for the management of functional ischemic mitral regurgitation with ischemic cardiomyopathy. However, mitral valve annuloplasty may create some degree of functional mitral stenosis. The purpose of this study was to compare the mitral valve hemodynamics in patients with functional ischemic mitral regurgitation undergoing mitral valve annuloplasty or mitral valve replacement, using exercise echocardiography. ⋯ In patients with functional ischemic mitral regurgitation, mitral valve annuloplasty may cause functional mitral stenosis, especially during exercise. Mitral valve annuloplasty was associated with poor exercise mitral hemodynamic performance, lack of mitral valve opening reserve, and markedly elevated postoperative exercise systolic pulmonary arterial pressure compared with mitral valve replacement.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyDifferentiating tuberculosis from sarcoidosis by sonographic characteristics of lymph nodes on endobronchial ultrasonography: a study of 165 patients.
The differential diagnosis of sarcoidosis and tuberculosis is difficult, especially in countries with a high tuberculosis burden. We hypothesized that sonographic features on endobronchial ultrasonography (EBUS) would help in differentiating tuberculosis from sarcoidosis. In this study, the endosonographic features of tuberculosis and sarcoidosis are compared. ⋯ Sonographic features of heterogeneous echotexture or coagulation necrosis in the lymph nodes on EBUS are fairly specific for tuberculosis. Along with a positive TST, these features strongly favor a diagnosis of tuberculosis over sarcoidosis.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Observational StudyPostoperative complications and association with outcomes in pediatric cardiac surgery.
Our primary aim was to study postoperative complications in pediatric cardiac surgery patients and their association with cardiopulmonary bypass (CPB) use. The secondary aim was to evaluate the association of postoperative complications with established outcome measures. ⋯ Postoperative complications occurred in 43% of pediatric cardiac surgeries performed both with and without CPB. The complications were associated with longer mechanical ventilation and pediatric cardiac intensive care unit and hospital stays, and increased mortality.