The Annals of thoracic surgery
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Case Reports Comparative Study
Surgical revascularization in patients with poor left ventricular function: on- or off-pump?
Patients with left ventricular dysfunction and low ejection fraction (EF) are at high-risk of complication and mortality after coronary artery bypass grafting (CABG). The potential success of off-pump CABG in this high-risk population has yet to be determined. The purpose of this study is to compare the outcome of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass (CCAB) in patients with poor left ventricular function, all from a single institution. ⋯ Patients with poor left ventricular function may undergo surgical revascularization using off-pump technique with relatively good results and low mortality levels. The lower number of grafts performed on the off-pump procedure did not seem to affect clinical outcomes.
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Obesity is epidemic in the United States and afflicts 97 million adults. Prior single center studies have been contradictory as to obese patients having higher risks with coronary artery bypass operations. Our objective was to assess the independent effect of both moderate (body mass index [BMI], 35 to 39.9) and extreme (BMI > or = 40) obesity on bypass operation outcomes using the Society of Thoracic Surgeons National Cardiac Database. ⋯ Extreme obesity (body mass index > or = 40) is a significant independent predictor for adverse outcomes and prolonged hospitalization after coronary artery bypass operation.
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This study investigates the possibility of reducing myocardial oxygen consumption by dynamic cardiomyoplasty in chronic heart failure. The sheep model used is relevant for cardiac assist using direct mechanical cardiac compression. ⋯ Despite limited hemodynamic improvement from dynamic cardiac compression by cardiomyoplasty in sheep with chronic heart failure, myocardial oxygen consumption was significantly reduced. These findings provide a rationale for reverse remodeling of the failing heart using direct mechanical compression.
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Revisions in the international system for the staging of lung cancer, adopted in 1997, assigned the T4 descriptor to separate tumor nodules in the same lobe and the M1 descriptor to tumor nodules in a different lobe. Consequently, these changes shifted the stage of patients with these lesions to stage IIIB or stage IV. The goal of this review was to determine the impact of multifocal non-small cell lung cancer on survival. ⋯ Although there was a trend toward decreased survival in patients with multifocal NSCLC compared with patients with stage I NSCLC, this did not achieve statistical significance. Importantly, survival in these subgroups of patients with stage IIIB or stage IV disease (stage determined solely on the basis of multifocal NSCLC) is better than the survival reported in the series that formed the foundation for these staging changes. These data support complete surgical resection of multifocal lung tumors in patients with node-negative NSCLC.
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A bidirectional cavopulmonary shunt has been performed for the high-risk Fontan patient. It is well known that in the presence of the bidirectional cavopulmonary shunt alone to secure pulmonary blood flow, the central pulmonary artery size decreases over time. We have performed pulsatile bidirectional cavopulmonary shunt (PBCPS), keeping pulmonary blood flow from the ventricle through the stenotic pulmonary valve, or a Blalock-Taussig shunt in patients who do not meet the criteria for the Fontan operation. ⋯ The PBCPS is useful for high-risk Fontan patients not only in the staged Fontan operation, but also as definitive palliation.