The Annals of thoracic surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
Effect of clopidogrel use post coronary artery bypass surgery on graft patency.
Clopidogrel use post coronary artery bypass grafting (CABG) has become more popular under the assumption that it improves graft patency. The purpose of this sub-analysis from the Randomized On and Off-Pump Bypass (ROOBY) trial is to evaluate the role of clopidogrel use post CABG to improve graft patency when added to standard aspirin therapy. ⋯ This study suggests that routine post-CABG clopidogrel use may not translate to improved 1-year graft patency. Future studies appear warranted to better define the role of more aggressive antiplatelet therapy post CABG on graft patency and clinical outcomes.
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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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Multicenter Study
Impact of perioperative acute kidney injury as a severity index for thirty-day readmission after cardiac surgery.
Of patients undergoing cardiac surgery in the United States, 15% to 20% are re-hospitalized within 30 days. Current models to predict readmission have not evaluated the association between severity of postoperative acute kidney injury (AKI) and 30-day readmissions. ⋯ In addition to more traditional patient characteristics, the severity of postoperative AKI should be used when assessing a patient's risk for readmission.
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Randomized Controlled Trial Comparative Study
Effect of hemostatic material on sternal healing after cardiac surgery.
Postoperative sternal infection and dehiscence cause increased morbidity, mortality, and socioeconomic costs as well as patient discomfort and pain. Some predisposing factors have been uncovered but others remain uninvestigated. Among these are the influence of topical hemostatic agents such as bone wax (BW) and Ostene (Ceremed Inc, Los Angeles, CA) a new, water-soluble polymer wax (WSW). The object of this study was to investigate the impact of topical hemostatic agents on sternal healing in patients. ⋯ The results from this study suggest that WSW provides a useful alternative to BW when topic hemostasis on the sternum is required.
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Comparative Study
Management of blood transfusion in aortic valve surgery: impact of a blood conservation strategy.
There are limited data in the literature concerning the effect of a blood conservation strategy (BCS) on aortic valve replacement (AVR) patients. ⋯ Perioperative BCS reduced RBC transfusion in AVR patients without an increase in mortality or morbidity. Guidelines for BCS in routine cardiac operations should be extended to AVR patients.