The Annals of thoracic surgery
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Comparative Study
Hypoxemia during one-lung ventilation for robot-assisted coronary artery bypass graft surgery.
Robot-assisted coronary artery bypass grafting requires continuous one-lung ventilation (OLV) to evacuate the thoracic cavity. Whether this ventilatory mode subjects patients to serious hypoxemia remains underinvestigated. ⋯ Robot-assisted two-stage coronary artery bypass surgery employing OLV could be complicated by serious hypoxemia especially at the minithoracotomy grafting stage and in patients with specific risk factors. Thus, when managing such patients, invasive monitoring and aggressive treatment of arterial desaturation are mandatory to ensure the patient's safety and procedural smoothness.
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Comparative Study
Association of gender and lowest hematocrit on cardiopulmonary bypass with acute kidney injury and operative mortality in patients undergoing cardiac surgery.
Nadir hematocrit on cardiopulmonary bypass (CPB) is a known risk factor for worse outcomes after cardiac surgery. Whether women, because of lower nadir hematocrit on CPB, are more prone to worse outcomes than men after cardiac surgery remains unknown. ⋯ Both men and women undergoing cardiac surgery on CPB were prone to the deleterious effects of hemodilution on renal function and death. Yet, despite greater hemodilution, women had a lower relative risk of AKI and death than men at lower nadir hematocrit values on CPB suggesting better tolerance to hemodilution in women.
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Comparative Study
A propensity-matched comparison of pleurodesis or tunneled pleural catheter in patients undergoing diagnostic thoracoscopy for malignancy.
Patients with a suspected malignant pleural effusion occasionally require thoracoscopy to achieve a diagnosis. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter (TPC) that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these 2 treatment groups. ⋯ This investigation found that a TPC provided palliation of patients' malignant pleural effusions and freedom from reintervention equal to that of talc pleurodesis after thoracoscopy while resulting in a shorter mean length of hospital stay and interval to the initiation of systemic therapy. Lower rates of operative morbidity were also seen in the TPC treatment group. This method of palliation of a malignant pleural effusion should be considered when diagnostic thoracoscopy reveals a malignant pleural effusion.
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Comparative Study
Dilatation of the remaining aorta after aortic valve or aortic root replacement in patients with bicuspid aortic valve: a 5-year follow-up.
The natural history and management of ascending aorta (AA) and arch dilatation in patients with bicuspid aortic valve (BAV) after aortic valve replacement (AVR) or aortic root replacement (ARR) remains controversial. Our aim is to identify dilatation of the remaining aorta after AVR or ARR in patients with BAV compared with patients with tricuspid aortic valve (TAV). ⋯ No significant dilatation of the AA or arch was observed after AVR or ARR, respectively, in patients when a cut-off diameter of 4.5 cm or greater was considered for replacement in patients with BAV compared with patients with TAV up to 5 years after operation. The need for aortic replacement at smaller diameters was not found.