The Annals of thoracic surgery
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Valve surgery is performed routinely in octogenarians. This study explored variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival. ⋯ Octogenarians can expect excellent survival after valve surgery. Those not discharged home had poorer long-term survival. Therefore, adequate resources should be secured so sicker patients receive the appropriate level of care.
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Complications may arise from the residual dissected arch and descending thoracic aorta after conventional ascending and hemiarch repair of acute DeBakey type I aortic dissection. To mitigate these complications, a total arch and elephant trunk procedure has been advocated. This case demonstrates a less invasive hybrid technique, performed in a single-stage fashion through a sternotomy without circulatory arrest or deep hypothermia, to achieve the benefits of the total arch and elephant trunk operation.
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Assessment of subtle neurocognitive decline after surgical procedures has been hampered by heterogeneous testing techniques and a lack of reproducibility. This review summarizes the sensitivity and specificity of biomarkers of neurologic injury to determine whether they can be applied in the postoperative period to accurately predict neurocognitive decline. ⋯ Glial fibrillary acidic protein is a sensitive marker, and there are extracranial sources that are antigenically different from the brain-derived form. Serum levels of tau protein after acute neurologic injury do not reliability correlate with incidence.