The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Multicenter StudyExtracorporeal membrane oxygenation as a bridge to pulmonary transplantation.
Acute clinical deterioration preceding death is a common observation in patients with advanced interstitial lung disease and secondary pulmonary hypertension. Patients with pulmonary arterial hypertension refractory to medical therapy are also at risk of sudden cardiac death (cor pulmonale). The treatment of these patients remains complex, and the findings from retrospective studies have suggested that intubation and mechanical ventilation are inappropriate given the universally poor outcomes. Extracorporeal support technologies have received limited attention because of the presumed inability to either recover cardiopulmonary function in the patient with end-stage disease or the presumed inability to proceed to definitive therapy with transplantation. ⋯ These observations challenge current assumptions about the treatment of selected patients with end-stage lung disease and suggest that "salvage transplant" is both technically feasible and logistically viable. Widespread adoption of artificial lung technology in lung transplant will require the design of clinical trials that establish the most effective circumstances in which to use these technologies. A discussion of a clinical trial and reconsideration of current allocation policy is warranted.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
ReviewIsolation of persistent air leaks and placement of intrabronchial valves.
Alveolar-pleural fistulas causing persistent air leaks are conditions associated with prolonged hospital courses, high morbidity, and possibly increased mortality. Intrabronchial valves serve as a noninvasive therapeutic option for the closure of alveolar-pleural fistulas. ⋯ The increased use of intrabronchial valves in the treatment of persistent air leaks requires bronchoscopists and clinicians to understand the procedural steps and techniques necessary for intrabronchial valve placement.
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Hypothermic circulatory arrest has been used during aortic arch repairs with acceptable neurologic outcomes. Through the years, we have studied the effects of deep hypothermia on brain metabolism and perfusion both in a pig model and in surgical patients. Hypothermic circulatory arrest has also been used as a method of organ protection in the repair of thoracoabdominal aortic aneurysms. We summarize the clinical and laboratory studies to support the routine use of hypothermic circulatory arrest in clinical practice.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: right-sided maze versus biatrial maze.
Although it has been inferred that a biatrial maze procedure for atrial fibrillation in left-sided heart lesions may lead to better outcomes compared with a limited left atrial lesion set, it remains controversial whether the biatrial maze procedure is superior to the right atrial maze procedure in right-sided heart lesions. ⋯ Left-sided ablation in addition to a right atrial maze procedure leads to better electrophysiologic outcome in atrial fibrillation associated with atrial septal defect.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Indications for aortic aneurysmectomy: too many variables and not enough equations?
Endografting for treatment of thoracic aortic pathology continues to gain popularity; in some countries, endovascular aortic repair numbers now exceed open surgery cases. The skills and understanding of open surgical teams are not always translated into endovascular interventions, which may be led by a cardiologist or vascular surgeon with little knowledge of thoracic pathology. The indications for intervention on the dilated aorta continue to be debated despite volumes of literature and multisocietal guidelines. ⋯ We also have no good measures of the material properties of the wall that determine strength, although a great deal of attention has been paid to the genetic markers for aortic wall abnormalities. Other factors, such as smoking or poorly controlled hypertension, likely should enter into our clinical assessment because they impact wall strength as well. For now, discussions with patients should be framed with all these elements in mind.