The Annals of thoracic surgery
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Surgical repair of total anomalous pulmonary venous connection (TAPVC) is associated with high rates of mortality and need for reintervention. The purpose of this study was to identify variables associated with surgical mortality and, in particular, to define predictors of recurrent pulmonary venous obstruction. ⋯ Mortality after repair of TAPVC is highest in patients presenting with obstruction at time of repair. Longer cardiopulmonary bypass and cross-clamp times are associated with recurrent pulmonary venous obstruction requiring reintervention. The strongest association with need for reintervention was in patients with intraoperative transesophageal echocardiography Doppler evidence of pulmonary venous obstruction.
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Comparative Study
Management of stage IIIA non-small cell lung cancer by thoracic surgeons in North America.
Stage IIIA(N2) non-small cell lung cancer is a heterogeneous spectrum ranging from microscopic lymph node metastases to bulky multistation nodal disease. While some favor surgical resection after neoadjuvant therapy, others favor definitive chemoradiation for treatment. Our aim was to determine practice patterns of thoracic surgeons. ⋯ There is no clear consensus on management of patients with stage IIIA lung cancer in the United States. Diversity of opinion is greatest in patients with more advanced lung cancer, and limited pulmonary function.
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Comparative Study
Outcome of extracorporeal membrane oxygenation as a bridge to lung transplantation and graft recovery.
Indications for extracorporeal membrane oxygenation (ECMO) use in lung transplantation are (1) temporary assistance as a bridge to transplantation, (2) stabilization of hemodynamics during transplantation in place of cardiopulmonary bypass, and (3) treatment of severe lung dysfunction and primary graft failure after transplantation. This study compares the survival of lung transplant recipients requiring ECMO support with survival of patients without ECMO. ⋯ Survival after lung transplantation was significantly reduced with ECMO. However, patients who survived the first year showed similar long-term survival as those patients who did not need perioperative ECMO support.
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We discuss 4 cases of plastic bronchitis (PB) after Fontan procedure observed at our Institution, with the aim to identify an effective treatment and possible factors favoring the onset of PB. Plastic bronchitis is an uncommon disease characterized by recurrent formation of large pale bronchial casts obstructing the tracheobronchial tree. The treatment includes inhaled or systemic steroids, aerosolized mucolytics, bronchoscopic lavage, direct bronchoscopic extraction and, in few reports, aerosolized fibrinolytic and pulmonary vasodilators. ⋯ The exact causes of PB in Fontan patients remain unknown. An early diagnosis and a multiple therapy with steroids, mucolytics, pulmonary vasodilators, and aerosolized tissue plasminogen activator may be effective.
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Comparative Study
Predicting in-hospital mortality after redo cardiac operations: development of a preoperative scorecard.
The present study generated a risk model and an easy-to-use scorecard for the preoperative prediction of in-hospital mortality for patients undergoing redo cardiac operations. ⋯ Reoperation represents a significant proportion of modern cardiac surgical procedures and is often associated with significantly higher mortality than first-time operations. We created an easy-to-use scorecard to assist clinicians in estimating operative mortality to ensure optimal decision making in the care of patients facing redo cardiac operations.