The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2011
Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival.
Aortic valve replacement in patients with aortic stenosis is usually followed by regression of left ventricular hypertrophy. More complete resolution of left ventricular hypertrophy is suggested to be associated with superior clinical outcomes; however, its translational impact on long-term survival after aortic valve replacement has not been investigated. ⋯ Our study is the first to suggest that enhanced postoperative left ventricular mass regression, specifically in patients undergoing aortic valve replacement for aortic stenosis, may be associated with improved long-term survival. In view of these findings, strategies purported to be associated with superior left ventricular mass regression should be considered when undertaking aortic valve replacement.
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J. Thorac. Cardiovasc. Surg. · Aug 2011
Intrathoracic phrenic pacing: a 10-year experience in France.
Phrenic pacing is an alternative to positive-pressure ventilation in selected patients, mostly in cases of upper spinal cord injury. We evaluated results of phrenic pacing performed by video-assisted thoracic surgery (VATS). ⋯ VATS implantation of 4-pole electrodes around the intrathoracic phrenic nerve is a safe procedure. Ventilatory weaning correlates with the degree of diaphragmatic amyotrophy. Phrenic pacing, performed as soon as neurologic and orthopedic stabilization is achieved, is the most important prognostic factor for successful weaning.
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J. Thorac. Cardiovasc. Surg. · Aug 2011
Comparative StudyOn-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial.
Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach. ⋯ In this large-scale study evaluating the outcomes of patients with acute coronary syndromes, off-pump coronary artery bypass grafting was associated with lower rates of bleeding and non-Q-wave myocardial infarction but more reinterventions early after the procedure. At 1 year, there was no major outcome difference between the 2 surgical strategies.
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J. Thorac. Cardiovasc. Surg. · Aug 2011
The Surgical Procedure Assessment (SPA) score predicts intensive care unit length of stay after cardiac surgery.
The ability to predict intensive care unit length of stay greatly facilitates triage and resource allocation for postoperative cardiac surgical patients in the intensive care unit. We developed a simple, intuitive Surgical Procedure Assessment score that integrates surgical complexity (1, low; 2, intermediate; 3, high) with patient comorbidity (A, minimal; B, substantial). We hypothesized that the Surgical Procedure Assessment score would predict intensive care unit length of stay, discriminate preoperatively between fast-track and prolonged-stay patients, and compare favorably with more complex risk scores. ⋯ The Surgical Procedure Assessment score predicts intensive care unit length of stay better than other comparable scores. It is simple, intuitive, and easily understood by all caregivers and can preoperatively discriminate fast-track from prolonged-stay patients. It is a useful tool to facilitate intensive care unit triage.
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J. Thorac. Cardiovasc. Surg. · Aug 2011
Cerebral near-infrared spectroscopy during cardiopulmonary bypass predicts superior vena cava oxygen saturation.
Cerebral and flank near-infrared spectroscopy are used to monitor tissue oxygenation during cardiopulmonary bypass in pediatric patients. We sought to validate these noninvasive measurements as predictors of oxygen saturation in the superior and inferior venae cavae during cardiopulmonary bypass. ⋯ Cerebral near-infrared spectroscopy accurately predicts superior vena cava oxygen saturation and changes in superior vena cava oxygen saturation on cardiopulmonary bypass. The relationship between flank near-infrared spectroscopy and inferior vena cava saturation is not as strong.