The Annals of thoracic surgery
-
Comparative Study
Risks of noncardiac operations and other procedures in children with complex congenital heart disease.
Children with complex congenital heart disease entail risk when undergoing noncardiac operations and other procedures requiring general anesthesia. To address concerns regarding intraoperative instability, need for postoperative mechanical ventilation, and postoperative hospital length of stay (LOS), we present our 5-year experience with 71 patients with complex congenital heart disease who underwent 252 surgical procedures. ⋯ Within this population, we have identified independent risk factors for specific clinical outcomes. Patients before stage II palliation, undergoing more invasive procedures, and receiving inotropes, angiotensin-converting enzyme inhibitors, or digoxin appear to be at risk for intraoperative hemodynamic instability. Patients with preoperative hospital LOS exceeding 14 days appear to be at greater risk for requiring postoperative mechanical ventilation. Patients with preoperative LOS exceeding 14 days, with ventricular dysfunction, receiving inotropes, and not receiving digoxin appear to be at risk for protracted hospitalization. Application of these results should assist clinicians in assessing perioperative risk.
-
Multicenter Study Comparative Study
Trends in acute kidney injury, associated use of dialysis, and mortality after cardiac surgery, 1999 to 2008.
The development of acute kidney injury (AKI) after cardiac surgery is associated with significant mortality, morbidity, and cost. The last decade has seen major changes in the complexity of cardiac surgical candidates and in the number and type of cardiac surgical procedures being performed. ⋯ In sum, despite improvements in individual patient outcomes over the decade 1999 to 2008, the population contribution of AKI and AKI-D to inpatient mortality after surgery increased over the same period.
-
Multicenter Study Comparative Study
Clinical characteristics and prognostic factors of primary pulmonary vein stenosis or atresia in children.
Primary pulmonary vein stenosis or atresia (PVS/A) is a rare entity with a high mortality rate. The aim of this study was to elucidate the clinical characteristics, progression, and prognostic factors of primary PVS/A in children. ⋯ Primary PVS/A may carry a significant risk of recurrent and progressive PV obstruction or death even after surgical venoplasty.
-
Comparative Study
The risk and outcomes of reoperative tricuspid valve surgery.
Outcomes after tricuspid valve reoperation have not been published before. This study examines our 32-year experience in this cohort of patients. ⋯ Redo tricuspid valve surgery is associated with high operative mortality and morbidity; however, survivors benefited from reasonable survival rates. Re-repair of the tricuspid valve is feasible in the majority of patients with functional tricuspid valve pathology, while the majority of patients with underlying organic pathology required a valve replacement.
-
Comparative Study
Preclinical study of near-infrared-guided sentinel lymph node mapping of the porcine lung.
The presence of lymph node metastasis is the most important prognostic factor in early non-small cell lung cancer. Our objective was to develop a rapid, simple, and reliable method for thoracic sentinel lymph node (SLN) identification using near-infrared fluorescence imaging and clinically available contrast agents. ⋯ Near-infrared fluorescence imaging with ICG is a reliable method for SLN mapping in the lung with high sensitivity. Mixing of ICG with plasma resulted in strong SLN fluorescence signal with reliable identification rates.