The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Comparative Study Observational StudyThe benefits of 24/7 in-house intensivist coverage for prolonged-stay cardiac surgery patients.
The objective of our study was to evaluate the efficacy of 24/7 in-house intensivist care for patients requiring prolonged intensive care unit (ICU) stay following cardiac surgery. ⋯ For patients requiring a prolonged ICU stay, our model of 24/7 in-house intensivist coverage was not associated with changes in ICU LOS, nor ICU and 30-day mortality. However a reduction in blood product use, ICU complications, and total hospital LOS was observed.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Nonphysiologic blood flow triggers endothelial and arterial remodeling in vivo: implications for novel left ventricular assist devices with a peripheral anastomosis.
Less invasive circulatory support devices have been developed that require anastomosis to a peripheral artery. The Symphony Heart Assist System (Abiomed, Inc, Danvers, Mass) is a volume-displacement pump sewn to the subclavian artery to provide partial circulatory support. The surgical configuration produces nonphysiologic blood pressure and bidirectional flow in the subclavian artery. Our objective was to identify effects of altered hemodynamics on arterial structure and function. ⋯ Assisted circulation with a left ventricular assist device triggered arterial remodeling that allowed a peripheral artery to accommodate the altered hemodynamics of a novel partial-support pump. Further delineation of remodeling pathways may be of significance for the emerging field of partial circulatory support.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Comparative Study Observational StudyMinimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy.
To compare the outcomes of right minithoracotomy (RT) versus ministernotomy (MS) in patients undergoing minimally invasive aortic valve replacement (AVR). ⋯ Minimally invasive AVR using RT was associated with lower postoperative morbidities and a shorter hospital stay than MS.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Observational StudyMitral procedure selection in patients on dialysis: does mitral repair influence outcomes?
To examine the likelihood of mitral valve repair among dialysis patients and the influence of mitral procedure selection on surgical outcomes in this cohort. ⋯ Dialysis patients undergo mitral repair less frequently, although repair success is equally likely when attempted among dialysis versus nondialysis patients. Dialysis-dependent renal failure is associated strongly with early mortality and major morbidity. However, procedure selection (repair vs replacement) does not appear to have a clinically meaningful impact on these short-term outcomes.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Preoperative B-type natriuretic peptide levels are associated with outcome after total cavopulmonary connection (Fontan).
The study objective was to determine the association between preoperative B-type natriuretic peptide levels and outcome after total cavopulmonary connection. Surgical palliation of univentricular cardiac defects requires a series of staged operations, ending in a total cavopulmonary connection. Although outcomes have improved, there remains an unpredictable risk of early total cavopulmonary connection takedown. The prediction of adverse postoperative outcomes is imprecise, despite an extensive preoperative evaluation. ⋯ Preoperative B-type natriuretic peptide blood levels are uniquely associated with the need for mechanical support early after total cavopulmonary connection and total cavopulmonary connection takedown, and thus may provide important information in addition to the standard preoperative assessment.