The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2013
ReviewSelective cerebral perfusion: a review of the evidence.
With the realization that hypothermia was neuroprotective, hypothermic selective antegrade cerebral perfusion was adopted by many surgical groups for aortic arch resection, prompting experimental and clinical studies to elaborate technical refinements and safe parameters of selective antegrade cerebral perfusion. We review the evidence for optimum management of perfusion pressure, flow, temperature, pH, hematocrit, and cannulation access. ⋯ On the basis of these experimental and clinical studies, certain recommendations for the use of nonpulsatile selective antegrade cerebral perfusion can be made.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
A clinical prediction rule for perioperative mortality and major morbidity after laparoscopic giant paraesophageal hernia repair.
In the current era, giant paraesophageal hernia repair by experienced minimally invasive surgeons has excellent perioperative outcomes when performed electively. However, nonelective repair is associated with significantly greater morbidity and mortality, even when performed laparoscopically. We hypothesized that clinical prediction tools using pretreatment variables could be developed that would predict patient-specific risk of postoperative morbidity and mortality. ⋯ Predictive models using pretreatment patient characteristics can accurately predict mortality and major morbidity after giant paraesophageal hernia repair. After prospective validation, these models could provide patient-specific risk prediction, tailored for individual patient characteristics, and contribute to decision-making regarding surgical intervention.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Multicenter StudyPrioritizing quality improvement in pediatric cardiac surgery.
Several efforts are under way to conduct quality-improvement initiatives in pediatric cardiology and cardiac surgery. Our goal was to develop an objective prioritization scheme for such initiatives based on encounter frequency and relative contribution of quality measures of morbidity (and associated variances), particularly in the setting of low mortality. ⋯ A small number of procedures account for a substantial burden of morbidity, even among low mortality risk groups. Consideration should be given to using such objective prioritization schemes to develop targeted quality-improvement measures.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Multicenter StudyImportance of false lumen thrombosis in type B aortic dissection prognosis.
Partial thrombosis of the false lumen has been reported as a significant predictor of mortality during follow-up in patients with acute type B aortic dissection. The purpose of this study was to investigate the correlation of false lumen thrombosis and aortic expansion during follow-up in patients with acute type B aortic dissection. ⋯ In patients with acute type B aortic dissection, aortic segments with a partially thrombosed false lumen have a significantly higher annual aortic growth rate when compared with those presenting with patent or complete thrombosis of the false lumen. Therefore, patients with partial thrombosis require more intensive follow-up and may benefit from prophylactic intervention.
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J. Thorac. Cardiovasc. Surg. · Mar 2013
Randomized Controlled TrialAdenosine instead of supranormal potassium in cardioplegia: it is safe, efficient, and reduces the incidence of postoperative atrial fibrillation. A randomized clinical trial.
We aimed to evaluate the efficacy and safety of a cold crystalloid cardioplegic solution with adenosine (1.2 mmol/L) instead of supranormal potassium. ⋯ Adenosine instead of hyperkalemia in cold crystalloid cardioplegia is safe, gives more rapid cardiac arrest, and affords similar cardioprotection and maintenance of hemodynamic parameters, together with a marked reduction in the incidence of postoperative atrial fibrillation.