The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jun 2018
Incidence and clinical implications of intraoperative bilateral internal thoracic artery graft conversion: Insights from the Arterial Revascularization Trial.
The Arterial Revascularization Trial has been designed to answer the question whether the use of bilateral internal thoracic arteries can improve 10-year outcomes when compared with single internal thoracic arteries. In the Arterial Revascularization Trial, a significant proportion of patients initially allocated to bilateral internal thoracic arteries received other conduit strategies. We sought to investigate the incidence and clinical implication of bilateral internal thoracic artery graft conversion in the Arterial Revascularization Trial. ⋯ The incidence of intraoperative bilateral internal thoracic artery graft conversion is not infrequent. Bilateral internal thoracic artery graft conversion is not associated with increased operative morbidity, but its effect on late outcomes remains uncertain.
-
J. Thorac. Cardiovasc. Surg. · Jun 2018
Multicenter StudyUrinary biomarkers may provide prognostic information for subclinical acute kidney injury after cardiac surgery.
This study aimed to determine the biomarker-specific outcome patterns and short-and long-term prognosis of cardiac surgery-asoociated acute kidney injury (AKI) identified by standard criteria and/or urinary kidney biomarkers. ⋯ Urinary kidney biomarkers identified RIFLE-negative patients with high-risk subclinical AKI as well as a higher risk subgroup of patients among RIFLE-AKI-positive patients. These findings support the concept that urinary biomarkers define subclinical AKI and higher risk subpopulations with worse long-term prognosis among standard patients with AKI.
-
J. Thorac. Cardiovasc. Surg. · Jun 2018
Multicenter StudyVariability in invasive mediastinal staging for lung cancer: A multicenter regional study.
Prior studies have reported underuse of-but not variability in-invasive mediastinal staging in the pretreatment evaluation of patients with lung cancer. We sought to compare rates of invasive mediastinal staging for lung cancer across hospitals participating in a regional quality improvement and research collaborative. ⋯ Rates of invasive mediastinal staging varied significantly across hospitals providing surgical care for patients with lung cancer. Future studies that aim to understand the reasons underlying variability in care may inform quality improvement initiatives or lead to the development of novel staging algorithms.
-
J. Thorac. Cardiovasc. Surg. · Jun 2018
Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children.
To determine the incidence of vocal cord paresis (VCP) after neonatal aortic arch repair/Norwood-type procedure, and the effectiveness of noninvasive laryngeal ultrasound in detecting VCP compared with gold standard invasive nasoendoscopy. ⋯ There is a high incidence of VCP after arch repair via sternotomy. Laryngeal ultrasound seems to be an effective and noninvasive method for detecting VCP in neonates and young children.
-
J. Thorac. Cardiovasc. Surg. · Jun 2018
Clinical outcomes of different surgical approaches for proximal descending thoracic aneurysm involving the distal arch.
The aim of this study was to evaluate clinical outcomes of different approaches to patients with proximal descending thoracic aneurysm (DTA) involving the distal arch. ⋯ The sternotomy approach showed better outcomes in terms of operative mortality, stroke, and long-term survival compared with the thoracotomy or hybrid approaches. This study suggests that the sternotomy approach is the superior option for patients with proximal descending aneurysm involving the distal arch.