The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2015
The addition of hemiarch replacement to aortic root surgery does not affect safety.
A hemiarch reconstruction, using deep hypothermic circulatory arrest, is the conventional approach for proximal aortic arch reconstruction, but it carries risks of neurologic events and coagulopathy. The addition of a hemiarch reconstruction to an aortic root replacement may prevent future aortic arch pathology. Outcomes of this approach at a tertiary care institution were examined to determine whether the addition of a hemiarch reconstruction to an aortic root replacement conferred any additional risk. ⋯ In this series, aortic root replacement ± hemiarch reconstruction had low mortality. Addition of hemiarch replacement extended perfusion times but not at the expense of safety. Hemiarch reconstruction should be performed when the aortic root aneurysm extends into the distal ascending aorta.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Observational StudyDefining indications for selective chest radiography in the first 24 hours after cardiac surgery.
In the intensive-care unit (ICU), chest radiographs (CXRs) are frequently obtained routinely for postoperative cardiac surgery patients, despite the fact that the efficacy of routine CXRs is known to be low. We investigated the efficacy and safety of CXRs performed after cardiac surgery for specified indications only. ⋯ Defining clear indications for selective CXRs after cardiac surgery is effective and seems to be safe. This approach may significantly reduce the total number of CXRs performed, and will increase their efficacy.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Clinical TrialIntraoperative molecular imaging can identify lung adenocarcinomas during pulmonary resection.
More than 80,000 people undergo resection of a pulmonary tumor each year, and the only method to determine if the tumor is malignant is histologic analysis. We propose that a targeted molecular contrast agent could bind lung adenocarcinomas, which could be identified using real-time optical imaging at the time of surgery. ⋯ Intraoperative molecular imaging with a targeted contrast agent can identify lung adenocarcinomas, and this technology is currently useful in patients with subpleural tumors, irrespective of size. With further refinements, this tool may prove useful in locating adenocarcinomas that are deeper in the lung parenchyma, in lymph nodes, and at pleural and resection margins.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Effect of patient age on blood product transfusion after cardiac surgery.
Blood product transfusion after cardiac surgery is associated with increased morbidity and mortality. Transfusion thresholds are often lower for the elderly, despite the lack of clinical evidence for this practice. This study examined the role of age as a predictor for blood transfusion. ⋯ In patients with a routine postoperative course, older age was associated with more postoperative blood transfusion. Older age was also predictive of longer length of stay and poorer survival, even after accounting for clinical factors. Continued study into effects of transfusion, particularly in the elderly, should be directed toward hospital transfusion protocols to optimize perioperative care.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Septal myectomy after failed alcohol ablation: Does previous percutaneous intervention compromise outcomes of myectomy?
The impact of prior alcohol septal ablation in patients who require septal myectomy for hypertrophic obstructive cardiomyopathy is unknown. ⋯ Patients with prior alcohol septal ablation undergoing surgical septal myectomy may have an increased risk of cardiac death, advanced heart failure, and implantable cardioverter defibrillator discharges. This supports septal myectomy as the preferred treatment for septal reduction therapy, avoiding scarring and diastolic dysfunction inherent to alcohol septal ablation.