The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2017
CommentEnhanced recovery pathway versus standard care in patients undergoing video-assisted thoracoscopic lobectomy.
The objective of this study was to compare outcomes after video-assisted thoracoscopic lobectomy or segmentectomy before and after introduction of an enhanced recovery program. ⋯ We found no benefit conferred by the enhanced recovery program on outcomes such as cardiopulmonary complications, 30- and 90-day mortality, length of stay, and readmissions. Enhanced recovery program elements may be insufficiently different than previous standards of perioperative care to confer detectable benefits in our settings.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Three-dimensional printing of navigational template in localization of pulmonary nodule: A pilot study.
Small pulmonary nodules are a common problem, especially with the wide implementation of lung cancer-screening program. This poses a great challenge to thoracic surgeons because of the difficulty of nodule localization. We recently built an efficient, customized navigational template using 3-dimensional (3D) printing technology to facilitate the procedure of lung nodule localization. This study aims to investigate its feasibility in clinical application. ⋯ This novel navigational template created by 3D printing technology is feasible, and it has acceptable accuracy for the application in lung nodule localization. The use of this navigational template could facilitate the procedure of lung nodule localization and may potentially break the dependence of percutaneous localization on computed tomography scanning.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Preoperative echocardiographic measures of left ventricular mechanics are associated with postoperative vasoactive support in preterm infants undergoing patent ductus arteriosus ligation.
Preoperative risk factors associated with poor outcomes after patent ductus arteriosus ligation in preterm infants have not been well defined. The aim of this study was to determine the association between preoperative echocardiographic measures of left ventricular mechanics and postoperative clinical outcomes after patent ductus arteriosus ligation. ⋯ End-systolic elastance and arterial elastance were the only predictors of postoperative vasoactive inotropic score after patent ductus arteriosus ligation in preterm infants. Those neonates with increased contractility and low afterload were at highest risk for elevated inotropic support. These findings suggest a role for echocardiographic end-systolic elastance and arterial elastance in the preoperative assessment of preterm infants undergoing patent ductus arteriosus ligation.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Comparative StudyThe importance of capillary density-stroke work mismatch for right ventricular adaptation to chronic pressure overload.
Mechanisms of right ventricular (RV) adaptation to chronic pressure overload are not well understood. We hypothesized that a lower capillary density (CD) to stroke work ratio would be associated with more fibrosis and RV maladaptive remodeling. ⋯ The RV adaptive response to chronic pressure overload differs between 2 different piglet models of PH. Mismatch between angiogenesis and workload (CD to stroke work ratio) was associated with greater degree of myocardial fibrosis and RV dysfunction and could be a promising index of RV maladaptation. Further studies are needed to understand the underlying mechanisms.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Recombinant human soluble thrombomodulin prevents acute lung injury in a rat cardiopulmonary bypass model.
Cardiopulmonary bypass (CPB) may induce systemic inflammatory responses causing acute lung injury. Recombinant human soluble thrombomodulin (rTM) is reported to attenuate the secretion of inflammatory cytokines and the high-mobility group box 1 (HMGB1) protein, which is critical in controlling systemic inflammation and apoptosis. We investigated the protective effects of rTM on CPB-induced lung injury in a rat model. ⋯ These results suggest that rTM prevents acute lung injury through attenuating inflammation and apoptosis during and after CPB in a rat model.