The Annals of thoracic surgery
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Comparative Study
Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality.
This study examined the relationship between transfusion of 1 or 2 units of red blood cells (RBCs) and the risk of morbidity and mortality after isolated on-pump coronary artery bypass grafting (CABG). ⋯ Transfusion of as little as 1 or 2 units of RBCs is common and is significantly associated with increased morbidity and mortality after on-pump CABG. The relationship persists after adjustment for preoperative risk factors. These results suggest that aggressive attempts at blood conservation and avoidance of even small amounts of RBC transfusion may improve outcomes after CABG.
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Comparative Study
Video-assisted thoracic surgery for pulmonary aspergilloma: a safe and effective procedure.
A variety of complications occur in patients with pulmonary aspergilloma. The safety and feasibility of a thoracoscopic approach to therapeutic lung resection for pulmonary aspergilloma have not been well evaluated. ⋯ Video-assisted thoracic surgery is an alternative to open procedures in the management of pulmonary aspergilloma. Simple aspergilloma and complex aspergilloma without infiltration of the hilum are good candidates for VATS resection. Aspergilloma lesions that require a pneumonectomy are still a major challenge for VATS.
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The impact of antegrade versus retrograde perfusion during cardiopulmonary bypass on short- and long-term outcome after repair for acute type A aortic dissection is controversial. ⋯ Survival during the initial perioperative period was equivalent comparing antegrade and retrograde perfusion. Antegrade perfusion to the true lumen, however, appears to be associated with superior long-term survival after hospital discharge.
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Case Reports
Aortic arch replacement through a left thoracotomy for right-sided aortic arch aneurysm with complete vascular ring.
Right-sided aortic arch with retroesophageal left subclavian artery and left ligamentum arteriosum is the second most common vascular ring. Aneurysms of the arch in its retroesophageal portion are rare. ⋯ The arch aneurysm was repaired with a staged approach. A right-sided carotid-subclavian artery bypass was performed, followed by distal ascending aorta and aortic arch replacement under hypothermic circulatory arrest through a left thoracotomy.
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Comparative Study
Failure-to-rescue rate as a measure of quality of care in a cardiac surgery recovery unit: a five-year study.
Failure to rescue, which is defined as the probability of death after a complication that was not present on admission, was introduced as a quality measure in the 1990s, to complement mortality and morbidity outcomes. The objective of this study was to evaluate possible incremental benefits of measuring failure to rescue after cardiac surgery, to facilitate quality improvement efforts. ⋯ Failure to rescue should be monitored as a quality-of-care metric, in addition to mortality and complication rates. Postoperative renal failure and septicemia still have a high failure-to-rescue rate and should be targeted by quality improvement efforts.