The Annals of thoracic surgery
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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.
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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.
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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.
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Comparative Study
Role of blebs and bullae detected by high-resolution computed tomography and recurrent spontaneous pneumothorax.
The prevention of recurrence after a first episode of primary spontaneous pneumothorax (PSP) remains a debated issue. The likelihood of recurrence based on the presence of blebs and bullae detected on high-resolution computed tomography (HRCT) imaging is controversial. ⋯ The presence of blebs and bullae at HRCT after a first episode of PSP is significantly related to the development of an ipsilateral recurrence or a contralateral episode of pneumothorax. Further studies are needed to validate the dystrophic severity score in the selection of patients for early surgical referral.