The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Platelet testing to guide aspirin dose adjustment in pediatric patients after cardiac surgery.
Thrombosis is associated with increased morbidity and mortality in pediatric patients undergoing cardiac surgery. Although aspirin commonly is used for thromboprophylaxis, the utility of laboratory-based tests that assess aspirin efficacy have not been evaluated. We sought to determine the relationship between platelet aggregation testing and aspirin dose adjustment on thrombosis rates in this population. ⋯ Current practice of weight-based aspirin dosing may lead to subtherapeutic platelet inhibition in some children. Aspirin unresponsiveness is associated with increased risk of thrombosis after specific pediatric cardiac surgical procedures. Aspirin dose increase in unresponsive patients is associated with reduced risk of thrombosis.
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Extracorporeal membrane oxygenation as a bridge to lung transplantation: A single-center experience in the present era.
Extracorporeal membrane oxygenation has been used as a bridge to lung transplantation in patients with rapid pulmonary function deterioration. The reported success of this modality and perioperative and functional outcomes are varied. ⋯ Extracorporeal membrane oxygenation can be used to safely bridge high-acuity patients with end-stage lung disease to lung transplantation with good 30-day, 90-day, and 1-year survival and excellent 1-year functional status. Long-term outcomes are being studied.
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Observational StudyTotal endovascular treatment for extent type 1 and 5 thoracoabdominal aortic aneurysms.
The study objective was to describe the results of thoracic endovascular aortic repair with the intentional coverage of the celiac artery and distal supramesenteric landing zone for extent type 1 and type 5 thoracoabdominal aortic aneurysms. ⋯ Thoracic endovascular aortic repair with intentional coverage of celiac artery for extent 1 and 5 thoracoabdominal aortic aneurysms had satisfactory results in selected patients at high risk for open repair. Visceral ischemia did not occur, but spinal cord ischemia is still high at 6%. At midterm follow-up, neither endoleak development nor aortic reintervention was related to the inadequate distal landing zone. Follow-up survival is satisfactory and comparable to open repair.
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J. Thorac. Cardiovasc. Surg. · Nov 2017
T category of non-small cell lung cancer invading the fissure to the adjacent lobe.
Dispute arises in the tumor category of non-small cell lung cancer invading the fissure to the adjacent lobe. The purpose of this study is to determine the long-term prognosis of non-small cell lung cancer with such an invasion and to propose an appropriate T category. ⋯ On the basis of our single-institution study, we propose that non-small cell lung cancer invading the fissure to the adjacent lobe should be further investigated and the impact on patients' prognoses validated as a T3 disease.
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J. Thorac. Cardiovasc. Surg. · Nov 2017
Outcomes of octogenarians discharged from the hospital after prolonged intensive care unit length of stay after cardiac surgery.
Octogenarians offered complex cardiac surgery frequently experience a prolonged intensive care unit length of stay; however, minimal data exist on the outcomes of these patients. We sought to determine the rates and predictors of 1-year noninstitutionalized survival ("functional survival") and rehospitalization for octogenarian patients with prolonged intensive care unit length of stay after cardiac surgery and who were discharged from hospital. ⋯ Octogenarians with prolonged intensive care unit length of stay have acceptable functional survival at 1 year but have high rates of early rehospitalization. Access to health services may influence functional survival and early rehospitalizations. These data suggest that close follow-up of these vulnerable patients after hospital discharge is warranted.