The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Comparative StudyImpact of ABO compatibility on outcomes after heart transplantation in a national cohort during the past decade.
Immunologic incompatibility has implications for primary graft failure, rejection, and survival in heart transplantation. To our knowledge, this is the first large cohort study investigating the impact of ABO-compatible versus identical blood type matching on post heart transplantation survival. ⋯ ABO-compatible transplantation does not result in adverse outcomes with respect to graft survival. Blood type O donor grafts, however, were associated with decreased survival. This has important implications for current graft allocation policies, particularly for type B recipients.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Process improvement in cardiac surgery: development and implementation of a reoperation for bleeding checklist.
High-performing health care organizations differentiate themselves by focusing on continuous process improvement initiatives aimed at enhancing patient outcomes. Reoperation for bleeding is an event associated with considerable morbidity risk. Hence, our primary objective was to develop and implement a formal operative checklist to reduce technical reasons for postoperative bleeding. ⋯ A substantial reduction in reoperation for bleeding cases followed implementation of a formalized hemostasis checklist. Our findings underscore the important influence of memory aids that focus attention on surgical techniques to improve patient outcomes in a complex, operative work environment.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Case ReportsPreoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries.
The management of patients with tetralogy of Fallot (ToF) and pulmonary atresia (PA) with major aortopulmonary collateral arteries (MAPCAs) is challenging. Frequently it is difficult to predict whether complete repair with closure of the ventricular septal defect (VSD) will be tolerated. The aim of this study was to investigate whether measurements of preoperative pulmonary blood flow are associated with early postoperative outcome after VSD closure. ⋯ CMR provides not only anatomic but also functional information for surgical decision making in patients with ToF and PA with MAPCAs. Preoperative Qp/Qs is associated with postoperative right ventricular pressure and may be a marker of readiness for VSD closure.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Prevention of retrosternal adhesion by novel biocompatible glue derived from food additives.
Postoperative retrosternal adhesion increases the risk of cardiac injury during cardiac reoperation. We created a novel biodegradable glue called "Lydex" that is derived from food additives. The purpose of this study is to evaluate this new biomaterial's biocompatibility and its preventive effect on retrosternal adhesion. ⋯ Our findings indicate that Lydex reduces retrosternal adhesion and attenuates the progression of fibrosis with excellent biocompatibility. Lydex is a next-generation substance for safer cardiac reoperation, with excellent capability for preventing adhesion, biocompatible and biodegradable properties, and lower potential for viral infections related to human plasma or other animal-derived products.
-
J. Thorac. Cardiovasc. Surg. · Nov 2013
Pulmonary sleeve resection in locally advanced lung cancer using cryopreserved allograft for pulmonary artery replacement.
During lobectomy, resection of pulmonary artery, followed by reconstruction or replacement with or without concomitant sleeve bronchial resection, is feasible in selected cases. We report morbidity, mortality, and technical issues in pulmonary artery replacement using a cryopreserved arterial allograft after sleeve resection for centrally located non-small cell lung carcinoma (NSCLC). ⋯ In central NSCLCs, conservative surgery using a cryopreserved arterial allograft to replace the pulmonary artery after extended segmental resection could avoid pneumonectomy in selected patients.