The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Left ventricular assist device as bridge to transplantation does not adversely affect one-year heart transplantation survival.
Left ventricular assist devices are increasingly used as a bridge to transplantation. It remains unclear whether the use of pretransplant left ventricular assist devices adversely affects short-term survival after cardiac transplantation. ⋯ When used as a bridge to transplantation, left ventricular assist devices do not compromise 1-year survival after cardiac transplantation. Of the patients who die after transplantation, patients bridged with left ventricular assist devices are at higher risk for death within 30 days of transplant. These data suggest that left ventricular assist devices as a bridge to transplantation should be considered for appropriately selected patients awaiting cardiac transplantation.
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Extracorporeal circulation by peripheral cannulation before redo sternotomy: indications and results.
Cardiac reoperations are challenging and time-consuming, and have a high risk for reentry injuries. We discuss the indications, advantages, and technologic features of cardiopulmonary bypass by peripheral cannulation before resternotomy. ⋯ In selected patients, cardiopulmonary bypass before resternotomy is a valid and reproducible option to render cardiac reoperations safer and more expeditious in the reentry phase. The absence of cannulae in the operating field makes the procedure more comfortable. The liberal use of this strategy is recommended in redo cases.
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program.
The main challenge of screening a healthy population with low-dose computed tomography is to balance the excessive use of diagnostic procedures with the risk of delayed cancer detection. We evaluated the pitfalls, difficulties, and sources of mistakes in the management of lung nodules detected in volunteers in the Cosmos single-center screening trial. ⋯ Low-dose computed tomography screening is effective for the early detection of lung cancers, but nodule management remains a challenge. Computed tomography-positron emission tomography is useful at baseline, but its sensitivity decreases significantly the subsequent year. Multidisciplinary management and experience are crucial for minimizing misdiagnoses.
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Comparative StudyEarly and long-term outcomes in the elderly: comparison between off-pump and on-pump techniques in 1191 patients undergoing coronary artery bypass grafting.
The aim of the present study was to investigate the influence of off-pump coronary artery bypass grafting on early and long-term mortality and morbidity in a consecutive series of elderly patients (aged > 65 years) compared with conventional coronary artery bypass grafting. ⋯ Our analysis shows that off-pump coronary artery bypass grafting compared with conventional coronary artery bypass grafting was associated with favorable early outcomes in the elderly population. However, the early benefits of off-pump coronary artery bypass grafting were not maintained in the long term, and off-pump coronary artery bypass grafting showed trends toward worse long-term results.