The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Transfusion of sex-mismatched and non-leukocyte-depleted red blood cells in cardiac surgery increases mortality.
To examine the mortality risk of blood transfusions when donor information, postdonation treatment, and a wide selection of risk factors are taken into account. ⋯ In this large retrospective study, transfusion of non-sex-matched RBCs was associated with increased mortality. In addition, in patients receiving small amounts of blood, leukocyte depletion of RBCs had a beneficial effect on patient survival.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
The risk and extent of neurologic events are equivalent for high-risk patients treated with transcatheter or surgical aortic valve replacement.
This study was designed to characterize the incidence of new clinically detectable neurologic events, or any comparative change in indices of higher cognitive function following transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) within the framework of a prospective, randomized clinical trial for high-risk patients. ⋯ This study defines an equivalent postprocedural stroke risk, stroke extent, and degree of cognitive change after TAVR or SAVR in a high-risk population, and also defines several predictors of stroke after TAVR.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Editorial ReviewContemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence.
Extracorporeal membrane oxygenation (ECMO) provides days to weeks of support for patients with respiratory, cardiac, or combined cardiopulmonary failure. Since ECMO was first reported in 1974, nearly 70,000 runs of ECMO have been implemented, and the use of ECMO in adults increased by more than 400% from 2006 to 2011 in the United States. A variety of factors, including the 2009 influenza A epidemic, results from recent clinical trials, and improvements in ECMO technology, have motivated this increased use in adults. Because ECMO is increasingly becoming available to a diverse population of critically ill patients, we provide an overview of its fundamental principles and a systematic review of the evidence basis of this treatment modality for a variety of indications in adults.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Pulmonary metastasectomy for suspected pancreaticobiliary cancer.
Occasionally, pancreaticobiliary cancer presents as a relatively indolent disease and localized blood-borne lung metastases may be resectable. We reviewed our experience with therapeutic lung resections in pancreatic cancer patients. ⋯ Although pancreaticobiliary cancers have an overall dismal prognosis, we recommend pulmonary metastasectomy in highly selected patients. Additionally, not all new lung masses in pancreatic cancer patients are metastases, and resection should be considered, for a second primary lung cancer is often found.