The Annals of thoracic surgery
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Lactic acidosis after cardiac surgery is a manifestation of excess cytokine production. Cytokine-related genetic polymorphisms account for variability in cytokine response and may predispose to the development of lactic acidosis after cardiac surgery. ⋯ Genetic factors have a role in the development of lactic acidosis after cardiac surgery.
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Previously, neurologic dysfunction was estimated to complicate 25% or less of pediatric open-heart operations. We sought to determine the current incidence and spectrum of early postoperative neurologic complications. ⋯ This review suggests a decrease in acute neurologic morbidity after pediatric open heart operation. Clinical seizures remain the most common complication. Posttransplant, cyclosporin-associated seizures have emerged as an important etiologic category, coincident with an increase in cardiac transplantation in children.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intracoronary shunts reduce transient intraoperative myocardial dysfunction during off-pump coronary operations.
This study investigated the hemodynamic changes in patients undergoing multiple vessel beating heart coronary revascularization in the presence or absence of an intracoronary shunt. ⋯ Stabilization of the left anterior descending coronary artery to perform the anastomosis resulted in temporary hemodynamic changes, which are prevented by the use of an intracoronary shunt. The hemodynamic deterioration during the construction of the posterior descending coronary artery and circumflex coronary artery anastomoses is transient in the shunt group, whereas the snaring technique is associated with an impairment of early functional recovery.
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Fistulous communication between the aorta and the pulmonary parenchyma developed in a 38-year-old woman 19 years after repair of a congenital aortic coarctation with Dacron patch aortoplasty. The fistula, inducing intermittent hemoptysis, arose from the suture line between the prosthetic fabric and the aorta. There was no infectious background or aneurysm at the primary repair site. The aortic segment including the prosthetic patch was resected and replaced with a Dacron tubular vascular prosthesis.
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Patients with prolonged intensive care unit (ICU) stays after cardiac operations are labor intensive and expensive. We sought to determine whether exhaustive ICU efforts result in survival or quality-of-life benefits and whether outcome could be predicted. ⋯ Patients remaining in the ICU for more than 14 days suffer a higher mortality at greater expense. A MODS at day 14 may help predict those who will not enjoy long-term survival and thus aid in the decision to terminate care.