The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 1999
Comparative StudyLong-term outcome after biologic versus mechanical aortic valve replacement in 841 patients.
The purpose of this study was to optimize selection criteria of biologic versus mechanical valve prostheses for aortic valve replacement. ⋯ For first-time, isolated aortic valve replacement, mechanical prostheses should be considered in patients under age 65 years with a life expectancy of at least 10 years. Bioprostheses should be considered in patients over age 65 years or with lung disease (in patients over age 60 years), renal disease, coronary disease, ejection fraction less than 40%, or a life expectancy less than 10 years.
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J. Thorac. Cardiovasc. Surg. · May 1999
Randomized Controlled Trial Comparative Study Clinical TrialDoes steroid pretreatment increase endotoxin release during clinical cardiopulmonary bypass?
The mechanism involved in the endotoxemia frequently recognized during cardiopulmonary bypass remains unclear. It has also been suggested that endotoxin levels were higher in steroid-pretreated patients undergoing cardiopulmonary bypass. ⋯ Endotoxin is released during cardiopulmonary bypass from the region drained by the inferior vena cava. Steroid pretreatment may actually reduce endotoxin release during bypass.
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J. Thorac. Cardiovasc. Surg. · May 1999
Multicenter Study Comparative StudyPrognostic models of thirty-day mortality and morbidity after major pulmonary resection.
A part of the prospective, multi-institutional National Veterans Affairs Surgical Quality Improvement Program was developed to predict 30-day mortality and morbidity for patients undergoing a major pulmonary resection. ⋯ This analysis identifies independent patient risk factors that are associated with 30-day mortality and morbidity for patients undergoing a major pulmonary resection. This series provides an initial risk-adjustment model for major pulmonary resections. Future refinements will allow comparative assessment of surgical outcomes and quality of care at many institutions.
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J. Thorac. Cardiovasc. Surg. · May 1999
Comparative StudyDoes the Adamkiewicz artery originate from the larger segmental arteries?
The Adamkiewicz artery supplies most of the blood to the anterior spinal artery, which perfuses the anterior two thirds of the spinal cord. During operations for thoracoabdominal aortic aneurysm, detailed anatomic knowledge of the Adamkiewicz artery and its correlation with the intercostal and/or lumbar arteries is important to prevent postoperative paraplegia. ⋯ This study provides evidence that, during operations on the thoracoabdominal aorta, the intercostal and/or lumbar arteries should be preserved, regardless of their diameter, to prevent postoperative paraplegia.