The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Randomized Controlled Trial Comparative StudyFluid management during video-assisted thoracoscopic surgery for lung resection: a randomized, controlled trial of effects on urinary output and postoperative renal function.
Increased perioperative fluid administration is an independent risk factor for lung injury after pulmonary resection. In clinical practice, fluid therapy is heavily guided by urinary output; however, diuretic response to plasma volume expansion has been reported to be blunted during anesthesia and surgery. We therefore hypothesized that in patients undergoing video-assisted thoracoscopic surgery, different regimens of intraoperative fluid management would not affect urinary output as would be expected in the nonsurgical scenario. Moreover, a restrictive perioperative fluid approach, as indicated in these operations, will not harm renal function. ⋯ In patients undergoing video-assisted thoracoscopic surgery, intraoperative urinary output and postoperative renal function are not affected by administration of fluids in the range of 2 to 8 mL/(kg · h). The clinical practice of administering fluids to enhance diuresis in the perioperative period should therefore be abandoned.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Adjuvant vancomycin for antibiotic prophylaxis and risk of Clostridium difficile infection after coronary artery bypass graft surgery.
The incidence of hospital-acquired Clostridium difficile infection (CDI) has increased rapidly over the past decade; patients undergoing major surgery, including coronary artery bypass grafting (CABG), are at particular risk. Intravenous vancomycin exposure has been identified as an independent risk factor for CDI, but this is controversial. It is not known whether vancomycin administered for surgical site infection prophylaxis increases the risk of CDI. ⋯ After adjustment for patient and surgical characteristics, a short course of prophylactic vancomycin was not associated with an increased risk of CDI among patients undergoing CABG surgery.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Contractile mitral annular forces are reduced with ischemic mitral regurgitation.
Forces acting on mitral annular devices in the setting of ischemic mitral regurgitation are currently unknown. The aim of this study was to quantify the cyclic forces that result from mitral annular contraction in a chronic ischemic mitral regurgitation ovine model and compare them with forces measured previously in healthy animals. ⋯ Mitral annular forces were measured for the first time in a chronic ischemic mitral regurgitation animal model. Our findings demonstrated an inferior left ventricular infarct to decrease significantly cyclic septal-lateral forces while modestly lowering those in the transverse. The measurement of these forces and their variation with left ventricular pressure contributes significantly to the development of mitral annular ischemic mitral regurgitation devices.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Risk factors for surgical site infection in pediatric cardiac surgery patients undergoing delayed sternal closure.
To determine the incidence of surgical site infections (SSIs) in congenital heart surgery (CHS) patients undergoing delayed sternal closure (DSC) and to evaluate risk factors for SSI. ⋯ For CHS patients undergoing DSC, extracorporeal membrane oxygenation and multiple periods of DSC are independent risk factors for SSI. New strategies for prevention and prophylaxis of SSI may be indicated for these high-risk patients who have worse outcomes and greater health care resource utilization.
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J. Thorac. Cardiovasc. Surg. · Aug 2013
Outcomes of cervical lymph node recurrence in patients with esophageal squamous cell carcinoma after esophagectomy with 2-field lymph node dissection.
The purpose of this study is to investigate the clinical characteristics, prognosis, and risk factors of patients in whom cervical lymph node cancer recurred after esophageal cancer surgery with 2-field lymph node dissection. ⋯ This study shows that 2-field lymph node dissection can be performed with an acceptable rate of cervical lymph node recurrence. Patients with isolated cervical lymph node recurrence demonstrated longer survival from diagnosis of recurrence than patients with other sites of recurrence.