The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2009
An Australian risk prediction model for 30-day mortality after isolated coronary artery bypass: the AusSCORE.
Our objective was to identify risk factors associated with 30-day mortality after isolated coronary artery bypass grafting in the Australian context and to develop a preoperative model for 30-day mortality risk prediction. ⋯ We have developed a preoperative 30-day mortality risk prediction model for isolated coronary artery bypass grafting for the Australian cohort.
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J. Thorac. Cardiovasc. Surg. · Oct 2009
Long-term results of right ventricular outflow tract reconstruction in neonatal cardiac surgery: options and outcomes.
Neonatal surgery for tetralogy of Fallot and truncus arteriosus requires reconstruction of the right ventricular outflow tract. Although the method of reconstruction is often dictated by the individual anatomy, choices exist. This review examines the durability and outcomes of right ventricular outflow tract reconstruction in the neonate. ⋯ The durability of neonatal right ventricular outflow tract reconstruction is diagnosis and method dependent. Anatomy allowing right ventricular outflow tract patching (either transannular or nontransannular) provides a durability advantage compared with that seen with a homograft. There was no difference in performance between aortic and pulmonary homografts, and the monocusp valve has limited durability and effectiveness in neonatal right ventricular outflow tract surgery. The long-term outcomes of transannular and nontransannular patching techniques for neonatal repair of tetralogy of Fallot/pulmonary stenosis are similar.
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J. Thorac. Cardiovasc. Surg. · Oct 2009
Pulmonary aspergilloma: analysis of prognosis in relation to symptoms and treatment.
This study was conducted to assess the risk of surgical treatment and to evaluate surgical resection in patients with pulmonary aspergilloma. ⋯ Our results indicate that (1) early morbidity and mortality rates of surgical treatment for pulmonary aspergilloma are acceptable, and (2) surgical treatment is helpful not only to reduce symptoms but also to prolong the survival of patients with pulmonary aspergilloma. Although more studies are needed, our data support the conclusion that surgical resection should be considered for all patients with pulmonary aspergilloma who have acceptable pulmonary reserve.
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J. Thorac. Cardiovasc. Surg. · Oct 2009
Prolonged mechanical ventilation after cardiac surgery: outcome and predictors.
Prolonged mechanical ventilation after cardiac surgery is a serious complication that warrants search for new treatment strategies. Our objective was to identify patients still requiring mechanical ventilation 3 days after the operation and those successfully weaned by day 10 to avoid needless and potentially hazardous interventions, such as tracheostomy. ⋯ A simple score based on postoperative day-3 physiologic parameters might help intensivists early identify patients with a strong likelihood of success in rapid weaning from mechanical ventilation and therefore prevent needless procedures aimed at reducing duration of mechanical ventilation and related complications.
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J. Thorac. Cardiovasc. Surg. · Oct 2009
Pre-Fontan cardiac magnetic resonance predicts post-Fontan length of stay and avoids ionizing radiation.
Patients frequently undergo cardiac catheterization before the Fontan operation because of the limited echocardiographic windows in the region of the superior cavopulmonary connection and branch pulmonary arteries. Patients with obstruction to pulmonary blood flow are at increased risk for prolonged length of hospital stay after the Fontan operation. Cardiac magnetic resonance has unlimited imaging windows and can quantify both the branch pulmonary artery size and net flow distribution and thereby serve as a method for identifying patients at increased risk for prolonged length of stay. ⋯ Cardiac magnetic resonance noninvasively assesses the branch pulmonary area size and flow before the Fontan operation. These data predict which patients are more likely to experience a prolonged hospital course.