The Annals of thoracic surgery
-
Comparative Study
Reoperation and mechanical circulatory support after repair of anomalous origin of the left coronary artery from the pulmonary artery: a twenty-year experience.
Although outcomes for repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) have improved, early postoperative mechanical circulatory support is occasionally still required. This study was undertaken to determine whether long-term outcomes for children supported with extracorporeal membrane oxygenation (ECMO) after ALCAPA repair differ from those in children who did not require ECMO. ⋯ Overall survival is excellent after ALCAPA repair. However, those patients who require mechanical support after repair appear to be at higher risk for transplantation or reoperation, typically for mitral regurgitation.
-
Anastomotic leak after intrathoracic esophagogastrostomy remains a dreaded complication of esophagectomy. Traditional therapy has most often consisted of reoperative repair or observation and drainage, each prolonging hospitalization and the initiation of oral nutrition. This investigation summarizes our experiences treating these patients using an occlusive, removable esophageal stent. ⋯ Endoluminal esophageal stent placement is a safe and effective method for the treatment of an intrathoracic anastomotic leak after esophagectomy. This treatment resulted in rapid leak occlusion, provided the opportunity for earlier oral nutrition, and avoided the potential morbidity of reoperative repair or esophageal diversion.
-
Review Meta Analysis
Skeletonized internal thoracic artery harvest improves prognosis in high-risk population after coronary artery bypass surgery for good quality grafts.
Skeletonization of the internal thoracic artery is supposed to achieve extra length with added advantages of decreased sternal complications. There is no agreement whether skeletonization affects grafts, main adverse cardiac events, mortality, or pulmonary function when compared with the conventional pedicled method. The aim of our study was to determine the effectiveness and safety of different harvesting techniques. ⋯ Skeletonized harvesting for the internal thoracic artery provides superiority to the quality of grafts with additional advantages of lesser trauma, producing fewer postoperative complications. Above all, skeletonized grafting in the high-risk population has a potential benefit in mortality and mainly adverse cardiac events.
-
Comparative Study
Postoperative anemia and exercise tolerance after cardiac operations in patients without transfusion: what hemoglobin level is acceptable?
Restrictive transfusion strategies have been suggested for cardiac surgical patients, leading to various degrees of postoperative anemia. This study investigates the exercise tolerance during rehabilitation of cardiac surgical patients who did not receive transfusions, with respect to their level of postoperative anemia. ⋯ Postoperative anemia with hemoglobin levels of 8 to 10 g/dL is well tolerated in patients who have not received a transfusion and induces only a transient impairment of exercise tolerance.