The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database.
Women with lung cancer have superior long-term survival outcomes compared with men, independent of stage. The cause of this disparity is unknown. For patients undergoing lung cancer resection, these survival differences could be due, in part, to relatively better perioperative outcomes for women. This study was undertaken to determine differences in perioperative outcomes after lung cancer surgery on the basis of sex. ⋯ Women have lower postoperative morbidity and mortality after lung cancer surgery. Some risk factors are sex-specific with regard to mortality. Further study is warranted to determine the cause of these differences and to determine their effect on survival.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Abnormal left ventricular diastolic function at late follow-up after repair of total anomalous pulmonary venous drainage: the impact of altered ventricular loading in utero.
Assessment of diastolic function has not been described after repair of total anomalous pulmonary venous drainage (TAPVD), but studies of exercise capacity demonstrate impaired performance in this population despite normal systolic function. We postulated that diastolic impairment might contribute to this finding. ⋯ Patients with repaired TAPVD are usually regarded as having excellent outcomes, but the finding of LV diastolic dysfunction in this population warrants more careful follow-up. We postulate that the diastolic impairment in these patients is the result of relative unloading of the LV during early cardiac development. These findings may also have implications in considering therapeutic approaches for hypoplastic ventricles in attempting to achieve biventricular repair.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Risk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation.
Patients requiring extracorporeal membrane oxygenation (ECMO) support after a Norwood operation constitute an extremely high-risk group. Data regarding risk factors for the requirement for ECMO post-Norwood are limited, however. We retrospectively assessed risk factors for requiring ECMO support after a Norwood operation during a 10-year period in a high-volume center. ⋯ Birth weight less than 2.5 kg and longer CPB time are independently associated with the need for ECMO after a Norwood operation. Peak serum lactate and peak VIS may be useful in stratifying risk for ECMO. Risk factors for ECMO post-Norwood appear to be similar to the risk factors for early mortality post-Norwood.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Surgical site infections and bloodstream infections in infants after cardiac surgery.
Few recent studies have assessed the epidemiology of and risk factors for surgical site infections (SSIs) and bloodstream infections (BSIs) in infants after cardiac surgery. We hypothesized that infants younger than 30 days old and those with higher Risk Adjustment in Congenital Heart Surgery-1 scores would have an increased risk of SSIs, but not an increased risk of BSIs after surgery. ⋯ SSIs and BSIs remain important complications after cardiac surgery in infants.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal.
A predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1%) or diffusing capacity of the lung for carbon monoxide (DLCO%) of <40% has traditionally been considered to convey a high risk of lobectomy owing to elevated postoperative morbidity and mortality. These recommendations, however, were largely derived from the pre-video-assisted thoracoscopic surgical (VATS) era. We hypothesized that VATS lobectomy would be associated with acceptable morbidity and mortality at ppoFEV1% and ppoDLCO% values < 40%. ⋯ VATS lobectomy can be performed with acceptable rates of morbidity and mortality in patients with reduced ppoFEV1% or ppoDLCO%.