The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center.
We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support. ⋯ We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.
Opioid-based anesthesia and analgesia is a traditional component of perioperative care for the cardiac surgery patient. Growing enthusiasm for Enhanced Recovery Programs (ERPs) coupled with evidence of potential harm associated with high-dose opioids suggests that we reconsider the role of opioids in cardiac surgery. ⋯ Based on the available literature and expert consensus, there is an opportunity to optimize anesthesia and analgesia for cardiac surgery patients. Although additional research is needed to establish specific strategies, core principles of pain management and opioid stewardship apply to the cardiac surgery population.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Randomized Controlled TrialPafolacianine for intraoperative molecular imaging of cancer in the lung: The ELUCIDATE trial.
The study objective was to determine the clinical utility of pafolacianine, a folate receptor-targeted fluorescent agent, in revealing by intraoperative molecular imaging folate receptor α positive cancers in the lung and narrow surgical margins that may otherwise be undetected with conventional visualization. ⋯ Intraoperative molecular imaging with pafolacianine improves surgical outcomes by identifying occult tumors and close surgical margins.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Aortic Area/Height Ratio, Peak Wall Stresses, and Outcomes in Veterans with Tricuspid vs Bicuspid Aortic Valve Associated Ascending Thoracic Aortic Aneurysms.
In ascending thoracic aortic aneurysm risk stratification, aortic area/height ratio is a reasonable alternative to maximum diameter. Biomechanically, aortic dissection may be initiated by wall stress exceeding wall strength. Our objective was to evaluate the association between aortic area/height and peak aneurysm wall stresses in relation to valve morphology and 3-year all-cause mortality. ⋯ Area/height was more predictive of high circumferential stresses in bicuspid than tricuspid valve aneurysms, but similarly less predictive of high longitudinal stresses in both valve types. Peak longitudinal stress, not area/height, independently predicted all-cause mortality. VIDEO ABSTRACT.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Natural History of Aortic Root Dilatation and Pathologic Aortic Regurgitation in Tetralogy of Fallot and its Morphological Variants.
We sought to characterize the natural history of aortic root dilatation and aortic regurgitation in tetralogy of Fallot (TOF). ⋯ Patients with TOF-variant are at comparatively greater risk of pathologic root dilatation over time, warranting closer longitudinal follow-up.