The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2022
Red blood cell exosome hemoglobin content increases after cardiopulmonary bypass and mediates acute kidney injury in an animal model.
Hemolysis, characterized by formation of free hemoglobin (Hb), occurs in patients undergoing cardiopulmonary bypass (CPB). However, there is no study of the dynamic changes in red blood cell (RBC)-derived exosomes (Exos) released during CPB, nor whether these particles mediate acute kidney injury (AKI). ⋯ These combined studies raise the potential for RBC-derived Exos, released during CPB, to target the kidney and mediate AKI.
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J. Thorac. Cardiovasc. Surg. · Dec 2022
A comparative study of robotic and laparoscopic approaches to Heller myotomy.
Minimally invasive Heller myotomy for achalasia is commonly performed laparoscopically, but recently done with robotic assistance. We compare outcomes of the 2 approaches. ⋯ Both robotically assisted and laparoscopic Heller myotomy had excellent outcomes in patients treated for achalasia. In a matched subgroup of patients with normal esophageal morphology within this heterogeneous disease, the robotic approach might be associated with greater esophageal emptying, palliation of symptoms, and freedom from reintervention in the intermediate term. Long-term analysis would be important to determine if this trend persists.
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J. Thorac. Cardiovasc. Surg. · Dec 2022
Modern practice and outcomes of reoperative cardiac surgery.
To evaluate recent practice and outcomes of reoperative cardiac surgery via re-sternotomy. Use of early versus late institution of cardiopulmonary bypass (CPB) before sternal re-entry was of particular interest. ⋯ Reoperative cardiac surgery is associated with low operative morbidity and mortality at an experienced center. Early and late CPB strategies have comparable outcomes in the context of an image-guided, team-based strategy.
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J. Thorac. Cardiovasc. Surg. · Dec 2022
Contemporary outcomes of the double switch operation for congenitally corrected transposition of the great arteries.
To determine the contemporary outcomes of the double switch operation (DSO) (ie, Mustard or Senning + arterial switch). ⋯ The outcomes of the DSO are promising. Earlier age at operation might favor better outcomes. Progressive neoaortic regurgitation and reinterventions on the neo-aortic valve are anticipated problems.
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J. Thorac. Cardiovasc. Surg. · Dec 2022
Observational StudyThe impact of pulmonary artery catheter use in cardiac surgery.
Pulmonary artery catheterization provides continuous monitoring of hemodynamic parameters that may aid in the perioperative management of patients undergoing cardiac surgery. However, prior data suggest that pulmonary artery catheterization has limited benefit in intensive care and surgical settings. Thus, this study sought to determine the impact of pulmonary artery catheter insertion on short-term postoperative outcomes in a large, contemporaneous cohort of patients undergoing open cardiac surgery compared with standard central venous pressure monitoring. ⋯ These findings suggest that pulmonary artery catheterization may have limited benefit in cardiac surgery.