The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Feb 2023
Validation of donor fraction cell-free DNA with biopsy-proven cardiac allograft rejection in children and adults.
Donor-specific cell-free DNA shows promise as a noninvasive marker for allograft rejection, but as yet has not been validated in both adult and pediatric recipients. The study objective was to validate donor fraction cell-free DNA as a noninvasive test to assess for risk of acute cellular rejection and antibody-mediated rejection after heart transplantation in pediatric and adult recipients. ⋯ Donor fraction cell-free DNA at a threshold of 0.14% can be used to assess for risk of rejection after heart transplantation in both pediatric and adult patients with excellent negative predictive value.
-
J. Thorac. Cardiovasc. Surg. · Feb 2023
Coronary artery bypass grafting after acute ST-elevation myocardial infarction.
The study objectives were to describe the trends and outcomes of isolated coronary artery bypass grafting after ST-elevation myocardial infarction using a nationwide database. ⋯ In this nationwide analysis, there has been a decline in the use of isolated coronary artery bypass grafting after ST-elevation myocardial infarction. Isolated coronary artery bypass grafting on day 1 was performed in sicker patients and was associated with higher in-hospital mortality than coronary artery bypass grafting performed on day 3 or more. In the recent cohort, isolated coronary artery bypass grafting on day 2 had similar in-hospital mortality compared with day 3 or more.
-
J. Thorac. Cardiovasc. Surg. · Feb 2023
Timing of reintervention influences survival and resource utilization following first-stage palliation of single ventricle heart disease.
Outcomes after first-stage palliation of single-ventricle heart disease are influenced by many factors, including the presence of residual lesions requiring reintervention. However, there is a dearth of information regarding the optimal timing of reintervention. We assessed if earlier reintervention would be favorably associated with in-hospital outcomes among patients requiring unplanned reinterventions after the Norwood operation. ⋯ For patients requiring predischarge unplanned reinterventions after the Norwood operation, earlier reintervention is associated with improved in-hospital transplant-free survival and resource use.
-
J. Thorac. Cardiovasc. Surg. · Feb 2023
Ex vivo lung evaluation of single donor lungs when the contralateral lung is rejected increases safe use.
The decision to perform a single-lung transplant (SLT) when the contralateral donor lung is rejected is a challenging scenario. The introduction of ex vivo lung perfusion (EVLP) has improved donor lung assessment, and we hypothesize that it has improved SLT outcomes in this setting. ⋯ The availability of EVLP allowed for better evaluation of marginal single lungs when the contralateral was declined. This has led to increased use rates with preserved outcomes despite use of more extended criteria organs.
-
J. Thorac. Cardiovasc. Surg. · Feb 2023
Dysphagia after cardiac surgery: Prevalence, risk factors, and associated outcomes.
The study objectives were to determine the prevalence of swallowing impairment in adults after cardiac surgery and examine associated risk factors and health-related outcomes. ⋯ Tracheal aspiration was prevalent, covert, and associated with increased morbidity and mortality.