The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2007
Comparative StudyElimination of daily routine chest radiographs does not change on-demand radiography practice in post-cardiothoracic surgery patients.
We sought to determine the effect of elimination of daily routine chest radiographs on chest radiographic practice in cardiothoracic surgery patients in the intensive care unit and the post-intensive care unit ward. ⋯ Elimination of daily routine chest radiographs led to a decrease of the total number of chest radiographs obtained per patient per day in the intensive care unit and did not change chest radiography practice in the post-intensive care unit ward.
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J. Thorac. Cardiovasc. Surg. · Jul 2007
Comparative Study Clinical TrialComparison of early platelet activation in patients undergoing on-pump versus off-pump coronary artery bypass surgery.
Cardiopulmonary bypass has been shown to be associated with platelet dysfunction, which has a potential for increasing the risk of perioperative bleeding. Off-pump coronary artery bypass surgery is thought to avoid this deleterious effect of pump use on platelets. However, the influence of off-pump coronary artery bypass surgery on platelets has not been thoroughly studied. ⋯ Early postoperative decrease in platelet count and increase in platelet activation occurs to a much lesser extent and does not alter bleeding time or adenosine diphosphate-induced platelet aggregation in patients undergoing off-pump coronary artery bypass surgery. This lack of significant effects on platelets might in part account for the potential decreased risk in bleeding and for the preserved hemostasis seen in patients undergoing off-pump coronary artery bypass surgery compared with those undergoing on-pump coronary artery bypass grafting surgery.
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J. Thorac. Cardiovasc. Surg. · Jul 2007
Comparative StudySurgical strategy for the bicuspid aortic valve: tricuspidization with cusp extension versus pulmonary autograft.
The congenitally bicuspid aortic valve is the most common etiologic factor associated with clinically significant aortic stenosis and/or regurgitation in pediatric patients. Beyond infancy, surgical intervention typically involves valve repair with cusp thinning and commissurotomy or valve replacement, primarily with pulmonary autograft in the current era. An aortic valve repair technique using tricuspidization with cusp extension was introduced in 1999. This study compares the midterm clinical outcome in patients undergoing valve repair by tricuspidization with cusp extension with those receiving a pulmonary autograft (Ross). ⋯ Reintervention rates in patients undergoing tricuspidization with cusp extension or a primary Ross procedure are similar. Valve performance in the TCE group is satisfactory at midterm follow-up, but the Ross repair appears to provide greater stability of valve function. These results suggest that repair with valve tricuspidization and cusp extension provides reliable palliation of the symptomatic bicuspid aortic valve.
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J. Thorac. Cardiovasc. Surg. · Jul 2007
A reinforced sternal wiring technique for transverse thoracosternotomy closure in bilateral lung transplantation: from biomechanical test to clinical application.
A high incidence of failure of transverse thoracosternotomy closure, involving the loops of wire cutting through the sternum, remains a significant morbidity after bilateral lung transplantation. We postulated that placing peristernal wires inside the usual longitudinal wires could prevent the longitudinal wires from cutting through the sternum. The aims of this study were to investigate the biomechanical and clinical efficacy of the proposed reinforced sternal closure technique. ⋯ Osteoporosis is a significant risk factor for sternal dehiscence after bilateral lung transplantation. The new reinforced sternal wiring technique provides biomechanically superior fixation of the sternum and clinically reduces the incidence of sternal dehiscence in high-risk osteoporotic patients undergoing bilateral lung transplantation.