The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Multicenter StudyGeographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery.
A number of established regional quality improvement collaboratives have partnered to assess and improve care across their regions under the umbrella of the Cardiac Surgery Quality Improvement (IMPROVE) Network. The first effort of the IMPROVE Network has been to assess regional differences in potentially discretionary transfusions (<3 units red blood cells [RBCs]). ⋯ Delivery of small volumes of RBC transfusions was common, yet varied across geographic regions. These data suggest that differences in regional practice environments, including transfusion triggers and anemia management, may contribute to variability in RBC transfusion rates.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Validation of association of the apolipoprotein E ε2 allele with neurodevelopmental dysfunction after cardiac surgery in neonates and infants.
Apolipoprotein E (APOE) genotype is a determinant of neurologic recovery after brain ischemia and traumatic brain injury. The APOE ε2 allele has been associated with worse neurodevelopmental (ND) outcome after repair of congenital heart defects (CHD) in infancy. Replication of this finding in an independent cohort is essential to validate the observed genotype-phenotype association. ⋯ These data validate the association of the APOE ε2 allele with adverse early ND outcomes after cardiac surgery in infants, independent of patient and operative factors. Genetic variants that decrease neuroresilience and impair neuronal repair after brain injury are important risk factors for ND dysfunction after surgery for CHD.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative Study Observational StudyThe influence of positive end-expiratory pressure on stroke volume variation in patients undergoing cardiac surgery: an observational study.
Measurements of stroke volume variation for volume management in mechanically ventilated patients are influenced by various factors, such as tidal volume, respiratory rate, and chest/lung compliance. However, research regarding the effect of positive end-expiratory pressure on stroke volume variation is limited. ⋯ The threshold value of stroke volume variation in predicting fluid responsiveness may change when positive end-expiratory pressure 10 cmH2O is applied. This must be considered when stroke volume variation is used to detect the fluid responsiveness to prevent volume overload in this mechanical ventilation setting.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
ReviewRenal and visceral protection in thoracoabdominal aortic surgery.
Open thoracoabdominal aortic aneurysm (TAAA) repair traditionally carries substantial perioperative morbidity and mortality, primarily from distal aortic ischemia. Advances in surgical techniques, adjuncts, and strategies have greatly improved outcomes. ⋯ Contemporary protective strategies allow open TAAA repair with substantially fewer renal and visceral ischemic complications. Although bowel ischemia is uncommon, renal failure remains a concern, especially in extent II and extent III TAAA repairs. Additional studies are needed to identify and improve renal protection strategies.
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J. Thorac. Cardiovasc. Surg. · Dec 2014
Comparative StudyShould early extubation be the goal for children after congenital cardiac surgery?
We sought to determine the feasibility and assess the clinical outcomes associated with an early extubation strategy for all children undergoing congenital heart surgery, including neonates (age, <30 days). ⋯ Most children undergoing congenital heart surgery can be extubated in the operating room. Most neonates, including many undergoing complex procedures, can be extubated within the first 24 hours after surgery. Early extubation was associated with low morbidity rates and short lengths of intensive care unit and hospital stays.