The Annals of thoracic surgery
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Case Reports
Pulmonary patch repair of tracheobronchial necrosis with perforation secondary to caustic ingestion.
Corrosive aerodigestive injury complicated by tracheobronchial necrosis is a rare complication after caustic ingestion that carries a high risk of mortality and morbidity. If left untreated, tracheobronchial necrosis results in perforation, mediastinitis, and death. ⋯ Frequent endoscopic surveillance leads to early diagnosis and prompt operative management to prevent significant morbidity. We describe a pulmonary patch repair of a patient who had stage 3b necrosis of the esophagus and the stomach with tracheobronchial necrosis and perforation after caustic ingestion.
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Multicenter Study
Association between preoperative statin use and acute kidney injury biomarkers in cardiac surgical procedures.
Acute kidney injury (AKI) is a serious complication of cardiac operations for which there remains no specific therapy. Animal data and several observational studies suggest that statins prevent AKI, but the results are not conclusive, and many studies are retrospective in nature. ⋯ Statins may prevent kidney injury after cardiac operations, as evidenced by lower levels of kidney injury biomarkers.
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Left atrial intramural hematoma is a rare complication of percutaneous intervention. We report the case of a 69-year-old man with recurrent angina after CABG 19 years ago who was admitted for percutaneous intervention. ⋯ Transesophageal echocardiography showed a large expanding hematoma within the left atrial wall causing obstruction of the mitral valve and compressing the right atrium from across the septum. An emergency thoracotomy was performed and with transesophageal echocardiography guidance and left atrial intramural hematoma was drained successfully.
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Comparative Study
A propensity-matched comparison of pleurodesis or tunneled pleural catheter for heart failure patients with recurrent pleural effusion.
Patients with severe heart failure often have recurrent pleural effusions that produce dyspnea and shortness of breath. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these two treatments. ⋯ This investigation found that a tunneled pleural catheter provided palliation of patients' pleural effusions and freedom from reintervention equal to that of talc pleurodesis using thoracoscopy while resulting in a shorter mean length of hospital stay. Lower rates of operative morbidity and readmission related to the pleural effusion were also seen in the tunneled catheter treatment group. This method of palliation of recurrent pleural effusion should be considered for symptomatic patients with advanced heart failure.
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China has the most patients with diabetes mellitus (DM) in the world and, annually, approximately 1 million Chinese become diabetic. We investigated both clinical and economic outcomes in a large Chinese cohort of diabetic patients undergoing coronary artery bypass graft surgery (CABG). ⋯ CABG for patients with DM was significantly more expensive and was associated with worse long-term outcomes compared with non-DM patients. The rising incidence of DM, combined with the significant incremental costs represents significant clinical, economic, and social challenges for the Chinese healthcare system.