The Annals of thoracic surgery
-
Multicenter Study
Contemporary Fontan operation: association between early outcome and type of cavopulmonary connection.
Extracardiac conduit and lateral atrial tunnel total cavopulmonary connection are both widely used in the management of functionally univentricular hearts. The effect of the type of connection on early outcomes after Fontan operation remains unclear. We evaluated the effect of Fontan type on early outcome in a large clinical database. ⋯ These multicenter data suggest that of the two prevalent forms of Fontan connection in current use, the lateral atrial tunnel Fontan may be associated with superior early outcomes.
-
Multicenter Study Comparative Study
Video-assisted thoracoscopic lobectomy is less costly and morbid than open lobectomy: a retrospective multiinstitutional database analysis.
The Premier Perspective Database (Premier Inc, Charlotte, NC) was used to compare hospital costs and perioperative outcomes for video-assisted thoracoscopic surgery (VATS) and open lobectomy procedures in the United States. ⋯ Lobectomy performed by the VATS approach as compared with an open technique results in shorter length of stay, fewer adverse events, and less cost to the hospital. Economic impact is magnified as the surgeon's experience increases.
-
Comparative Study
Transesophageal and contact ultrasound echographic assessments of pulmonary vessels in bilateral lung transplantation.
Intraoperative transesophageal echocardiographic visualization of the vascular anastomosis of lung grafts can be difficult. The goal of this prospective study was to compare intraoperative transesophageal echocardiography and contact ultrasound. ⋯ These results suggest clinicians should exercise caution when making treatment decisions when using transesophageal echocardiography alone.
-
Delirium is a common neurologic complication after cardiac surgery, and may be associated with increased morbidity and mortality. Research has focused on potential causes of delirium, with little attention to its sequelae. ⋯ There was an association between delirium and adverse outcomes after CABG that persisted beyond the immediate perioperative period. Patients with delirium after CABG appear to have an increased long-term risk of death and stroke. The advancing age and rising rates of delirium in the CABG population make it necessary to address the prevention and management of delirium in this population.
-
Case Reports
Secondary abdominal compartment syndrome causing failure to wean from cardiopulmonary bypass.
The abdominal compartment syndrome has been associated with trauma or primary abdominal procedures. The secondary abdominal compartment syndrome which is not associated with a primary abdominal process is seen in burns and other clinical situations where aggressive fluid resuscitation is needed. This case report describes a secondary abdominal compartment syndrome that occurred during an elective coronary revascularization which resulted in an inability to wean from cardiopulmonary bypass (CPB). After a decompressive laparotomy was done, the patient was successfully weaned from bypass.