The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2011
Multicenter StudyIndividualized computer-based surgical planning to address pulmonary arteriovenous malformations in patients with a single ventricle with an interrupted inferior vena cava and azygous continuation.
Pulmonary arteriovenous malformations caused by abnormal hepatic flow distribution can develop in patients with a single ventricle with an interrupted inferior vena cava. However, preoperatively determining the hepatic baffle design that optimizes hepatic flow distribution is far from trivial. The current study combines virtual surgery and numeric simulations to identify potential surgical strategies for patients with an interrupted inferior vena cava. ⋯ This study demonstrates how virtual surgery environments can benefit the clinical community, especially for patients with a single ventricle with an interrupted inferior vena cava. Furthermore, the sensitivity of the optimal baffle design to the superior inflows underscores the need to characterize both preoperative anatomy and flows to identify the best option.
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J. Thorac. Cardiovasc. Surg. · May 2011
Predictors of recurrence and disease-free survival in patients with completely resected esophageal carcinoma.
The goal of this study was to analyze factors predictive of recurrence and disease-free survival in patients with completely resected esophageal carcinoma. ⋯ For patients with completely resected esophageal cancer, independent predictors of improved freedom from recurrence and disease-free survival include good performance status, en bloc resection, and early pathologic stage.
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J. Thorac. Cardiovasc. Surg. · May 2011
Heparinized cardiopulmonary bypass circuits and low systemic anticoagulation: an analysis of nearly 6000 patients undergoing coronary artery bypass grafting.
Heparin coating of cardiopulmonary bypass circuits reduces the inflammatory response and increases the thromboresistance during extracorporeal circulation. These properties enables a lower systemic heparin dose, which has been shown to reduce the need for blood transfusions. Experience with this technique accumulated over 11 years has been analyzed. ⋯ The experience with this patient cohort including mostly low- to medium-risk patients with a relatively short cardiopulmonary bypass time indicates that coronary artery bypass grafting performed with heparin-coated circuits and reduced level of systemic heparinization is safe and results in a very satisfactory clinical course. No signs of clotting or other technical incidents were recorded.
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J. Thorac. Cardiovasc. Surg. · May 2011
Does lung allocation score maximize survival benefit from lung transplantation?
The lung allocation score was initiated in May 2005 to allocate lungs on the basis of medical urgency and posttransplant survival. However, the relationship between lung allocation score and candidate outcomes remains poorly characterized. The purpose of this study was (1) to describe outcomes by lung allocation score at the time of listing and (2) to estimate the net survival benefit of transplantation by lung allocation score. ⋯ The mid-priority groups (eg, 50-59, 60-69, 70-79) seem to achieve the greatest survival benefit from transplantation. Although low-priority candidates comprise the majority of transplant recipients, survival benefit in this group seems to be less than in other groups given the low risk of death on the waiting list. As expected, both the time to transplant and survival on the waitlist are lower in the higher-priority strata (eg, 80-89 and 90+). However, their net survival benefit was likewise relatively low as a result of their poor posttransplant survival.
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J. Thorac. Cardiovasc. Surg. · May 2011
Comparative StudyBronchiolitis obliterans syndrome occurs earlier in the post-lung allocation score era.
In 2005, the time-based waiting list for lung transplantation was replaced by an illness/benefit lung allocation score (LAS). Although short-term outcomes after transplantation have been reported to be similar before and after the new system, little is known about long-term results. The objective of this study was to evaluate the impact of LAS on the development of bronchiolitis obliterans syndrome as well as on overall 3-year and bronchiolitis obliterans syndrome-related survival. ⋯ In the current LAS era, lung transplant recipients have significantly fewer bronchiolitis obliterans syndrome-free days after 3-year follow-up. Compared with the pre-LAS population, overall and bronchiolitis obliterans syndrome-related survival appears worse in the post-LAS era. Limitation of known risk factors for development of bronchiolitis obliterans syndrome-may prove even more important in this patient population.