The Annals of thoracic surgery
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Thoracoscopic lobectomy is performed with increasing frequency for early-stage lung cancer. Several published reports suggest thoracoscopic resection is safe, with the potential advantage of shorter hospital stay, quicker recovery, and comparable oncologic results. ⋯ Thoracoscopic lung resection can be performed safely in selected patients aged 80 years and older, in those with marginal pulmonary function, and in those with pathologic response to neoadjuvant therapy.
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Small body size, female gender, and transfusions are traditionally considered morbidity and mortality risk factors in coronary surgery. Because these clinical conditions are interrelated, we designed a study to investigate their respective roles in determining adverse outcomes after coronary operations. ⋯ Female gender and small body surface area are associated with severe intraoperative hemodilution, and this may trigger blood transfusions, which are true determinants of adverse outcomes. A large body surface area in women is frequently associated with obesity (68%) and may prolong the intensive care unit stay, whereas it is not a risk factor in men. Conversely, a small body surface area is accompanied by a prolonged intensive care unit stay in men but not in women.
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In this prospective study, we investigated the determinants of long-term outcome, symptoms, and left ventricular function after coronary artery bypass grafting in patients with a moderate to severely decreased left ventricular ejection fraction. ⋯ Coronary artery bypass grafting for patients with moderate-to-severe left ventricular dysfunction is associated with acceptable long-term results. The left ventricular end-systolic volume index is a simple noninvasive method to aid in the preoperative decision making in such patients.
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Randomized Controlled Trial
Carbon dioxide field flooding reduces neurologic impairment after open heart surgery.
Air emboli released from incompletely deaired cardiac chambers may cause neurocognitive decline after open heart surgery. Carbon dioxide (CO2) field flooding is reported to reduce residual intracavital air during cardiac surgery. A protective effect of carbon dioxide insufflation on postoperative brain function remains unproven in clinical trials. ⋯ Shorter P300 peak latencies after surgery indicate less brain damage in patients who underwent heart valve operations with CO2 flooding of the thoracic cavity. Even if these findings were not supported by clinical results or neurocognitive test batteries in our cohort, carbon dioxide field flooding has proven efficiency and should be advocated for all patients undergoing open heart surgery.
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Review Comparative Study
Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery thymectomy.