The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2022
Creatinine elevations from baseline at the time of cardiac surgery are associated with postoperative complications.
Baseline kidney function is a key predictor of postoperative morbidity and mortality. Whether an increased creatinine at the time of surgery, compared with the lowest creatinine in the 3 months before surgery, is associated with poor outcomes has not been evaluated. We examined whether creatinine elevations from "baseline" were associated with adverse postoperative outcomes. ⋯ Elevations in creatinine at the time of surgery above the "baseline" level are associated with increased postoperative morbidity. Baseline creatinine should be established before surgery, and small changes in creatinine should trigger heightened vigilance in the postoperative period.
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J. Thorac. Cardiovasc. Surg. · Apr 2022
A system-wide extracorporeal membrane oxygenation quality collaborative improves patient outcomes.
Extracorporeal membrane oxygenation (ECMO) use in adult patient populations has grown rapidly with wide variation in practices and outcomes. We evaluated the impact on patient outcomes, resource use, and costs of an initiative to coordinate and standardize best practices across ECMO programs within a large integrated health care system. ⋯ The ECMO Collaborative Project improved survival to discharge/transfer, weaning rates and complications, without additional costs, through coordination and standardization across ECMO programs within a health care system.
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J. Thorac. Cardiovasc. Surg. · Apr 2022
Right gastroepiploic artery versus right internal thoracic artery composite grafts: 10-year patency and long-term outcomes.
We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (RITA) composite grafts. ⋯ Total arterial revascularization using RGEA composite grafts showed comparable results to those using RITA composite grafts in terms of the 10-year occlusion rates and long-term clinical outcomes.
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J. Thorac. Cardiovasc. Surg. · Apr 2022
Hepatorenal dysfunction assessment with the Model for End-Stage Liver Disease Excluding INR score predicts worse survival after heart transplant in pediatric Fontan patients.
Fontan physiology results in multiorgan dysfunction, most notably affecting the liver and kidney. We evaluated the utility of Model for End-Stage Liver Disease Excluding INR (MELD-XI) score, a score evaluating the function of both liver and kidney to identify Fontan patients at increased risk for morbidity and mortality post-heart transplant. ⋯ The MELD-XI, an easily calculated score, serves as a valuable aid in identifying pediatric Fontan patients at increased risk for post-heart transplant mortality.
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J. Thorac. Cardiovasc. Surg. · Apr 2022
Pulmonary artery size on computed tomography is associated with major morbidity after pulmonary lobectomy.
To investigate the relationship of pulmonary artery diameter (PAD) measured by computed tomography (CT) with outcomes following lobectomy. ⋯ CT-based measurements of the PAD on the operative side may inform of the about the risk of major complications after lobectomy. Review of PA size on preoperative CT scans may help identify patients who would benefit from formal evaluation of PA pressures to improve the operative risk assessment.