The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jun 2017
Meta AnalysisIncidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery: A systematic review and meta-analysis.
This systematic review and meta-analysis was performed to determine whether timing or type of tracheostomy was associated with superficial or deep sternal wound infections after cardiac surgery. ⋯ The incidence of sternal wound infection after tracheostomy in patients undergoing cardiac surgery remains high at 7% (95% CI, 4-10). Open or percutaneous tracheostomy after cardiac surgery is a feasible option because the incidence of sternal wound infection and short-term mortality are comparable. Moreover, the timing of tracheostomy (early or late) had comparable rates of sternal wound infection and short-term mortality.
-
J. Thorac. Cardiovasc. Surg. · Jun 2017
Multicenter Study Observational StudyPneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network.
Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. ⋯ Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. After we adjusted for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.
-
J. Thorac. Cardiovasc. Surg. · Jun 2017
Multicenter StudyVariation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals.
In a multicenter cohort of neonates recovering from cardiac surgery, we sought to describe the epidemiology of extubation failure and its variability across centers, identify risk factors, and determine its impact on outcomes. ⋯ This multicenter study showed that 11% of neonates recovering from cardiac surgery fail initial postoperative extubation. Only congenital airway anomaly was independently associated with extubation failure. We observed a 4-fold variation in extubation failure rates across hospitals, suggesting a role for collaborative quality improvement to optimize outcomes.
-
J. Thorac. Cardiovasc. Surg. · Jun 2017
Observational StudyElective primary aortic root replacement with and without hemiarch repair in patients with no previous cardiac surgery.
Excellent outcomes have been established for elective aortic root replacement (ARR). It is less clear whether extending the repair into the proximal aortic arch with hypothermic circulatory arrest increases risk. We examined the early outcomes of elective, primary ARR, with and without hemiarch replacement, in patients without previous cardiac surgery. ⋯ In non-redo patients, elective primary ARR has excellent early outcomes, regardless of whether repair extends into the proximal arch. Additional elective hemiarch replacement with moderate hypothermic circulatory arrest and antegrade cerebral perfusion has a low risk of neurologic complications and should be performed if necessary. Long-term data are needed to compare the rates of reintervention in the aortic arch in patients with or without proximal arch replacement.
-
J. Thorac. Cardiovasc. Surg. · Jun 2017
WebcastsPulmonary artery sealing with ultrasonic energy in open lobectomy: A phase I clinical trial.
Pulmonary artery branch sealing in video-assisted thoracoscopic surgical lobectomy is usually achieved with vascular endostaplers. Iatrogenic pulmonary artery injury may be caused by endostaplers. We evaluated the safety of pulmonary artery sealing with an ultrasonic energy vessel-sealing device in a phase I clinical trial evaluating in vivo safety of the device during open lobectomy. ⋯ Pulmonary artery sealing for vessels with diameter ≤7 mm was safely achieved with an ultrasonic energy vessel-sealing device in open lobectomy. The use of ultrasonic energy vessel-sealing devices in video-assisted thoracoscopic surgical lobectomy may have the advantage of making small, short, pulmonary artery branch sealing safer than with vascular endostaplers. Further studies are necessary before widespread application in lobectomy, including video-assisted thoracoscopic surgical lobectomy.