The Annals of thoracic surgery
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Comparative Study
The impact of specific preoperative organ dysfunction in patients undergoing aortic valve replacement.
Optimizing treatment strategies to risk profile patients undergoing aortic valve replacement remains a priority. The role that specific and combinations of preoperative organ dysfunction (OD) plays in informing these decisions remains uncertain. This study sought to determine the relative effect that OD in particular systems has on short- and long-term outcomes. ⋯ The presence of chronic renal failure most profoundly decreases survival, followed by severe chronic obstructive pulmonary disease and prior stroke. Furthermore, multiple OD systems significantly decrease short- and long-term survival.
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Case Reports
Fulminate heparin-induced thrombocytopenia and surgery with deep hypothermic circulatory arrest using bivalirudin.
After on-pump coronary artery bypass graft surgery, a patient had acute heparin-induced thrombocytopenia with thoracic arterial and venous thrombus formations. Complex emergency surgery with cardiopulmonary bypass and deep hypothermic circulatory arrest using bivalirudin anticoagulation was performed.
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Pulmonary carcinoid and pulmonary lymphoma are both rare cancers and are seldom seen together. Cases have been reported of their coexistence in the gastrointestinal tract, but our literature searches only found a single case of their coexistence in the lung. We discuss our case as well as the literature to try to find a connection and explanation for this occurrence.
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Comparative Study
Simulation-based postcardiotomy extracorporeal membrane oxygenation crisis training for thoracic surgery residents.
We developed and tested a clinical simulation program in the principles and conduct of postcardiotomy extracorporeal membrane oxygenation (ECMO) with the aim of improving confidence, proficiency, and crisis management. ⋯ We developed a simulation-based postcardiotomy ECMO training program that resulted in improved ECMO confidence in thoracic surgery residents. Crisis management in a simulated environment enabled residents to acquire technical and behavioral skills that are important in managing critical ECMO-related problems.
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Case Reports
Atrioesophageal fistula after surgical unipolar radiofrequency atrial ablation for atrial fibrillation.
Atrial fibrillation is the most common arrhythmia in the United States. Procedural treatment options such as the MAZE procedure and radiofrequency ablation are available with reasonable success rates. However, there are risks inherent to these procedures, with atrioesophageal fistula being a rare but devastating complication. We report a patient with atrioesophageal fistula who presented with neurologic symptoms 20 days after her initial MAZE procedure, followed by a quick decline within 24 hours of presentation.