The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyFrailty and risk in proximal aortic surgery.
Although frailty has recently been examined in various populations as a predictor of morbidity and mortality, its effect on thoracic aortic surgery outcomes has not been studied. The objective of the present study was to evaluate the role of frailty in predicting postoperative morbidity and mortality in patients undergoing proximal aortic replacement surgery. ⋯ Frailty, as defined using a 6-component frailty index, can serve as an independent predictor of discharge disposition and early and late mortality risk in patients undergoing proximal aortic surgery. These frailty markers, all of which are easily assessed preoperatively, could provide valuable information for patient counseling and risk stratification before proximal aortic replacement.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
A prospective study of growth and rupture risk of small-to-moderate size ascending aortic aneurysms.
The natural history of small-to-moderate size ascending aortic aneurysms is poorly understood. To follow these patients better, we have developed a method to objectively and reproducibly measure ascending aortic volume on the basis of gated contrast computed tomography scans. ⋯ Computed tomography volume measurements provide an objective method for ascertaining aortic size and monitoring expansion. Patients with small-to-moderate ascending aortic aneurysms who are carefully followed and managed appropriately have slow aneurysm growth and a small risk of rupture or dissection. Annual computed tomography screening may not be indicated, and elective resection-absent other surgical indications-is not necessary. The rupture/dissection risk for even larger aneurysms in carefully followed patients may be lower than currently believed.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Understanding variability in hospital-specific costs of coronary artery bypass grafting represents an opportunity for standardizing care and improving resource use.
This study was undertaken to examine interhospital variability in inpatient costs of coronary artery bypass grafting (CABG). ⋯ There is a wide variation in the cost of performing CABG in the United States. We determined that individual hospital centers, independent of multiple patient- and outcome-specific factors, are drivers of these differences. Comparison of hospital-specific behavior with identification of the causes of cost discrepancies represents an opportunity for standardization of care and improvement in resource use.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Paracorporeal lung assist devices as a bridge to recovery or lung transplantation in neonates and young children.
To evaluate paracorporeal lung assist devices to treat neonates and children with decompensated respiratory failure as a bridge to recovery or lung transplantation. ⋯ Pediatric patients bridged from ECMO to lung transplantation have poor results. An alternative method for longer term respiratory support was necessary as a bridge for these patients. The use of a paracorporeal lung assist device successfully supported 4 patients to recovery, lung transplantation, or past the average wait time for pediatric donor lungs (27 days). This therapy has the potential to bridge children with decompensated respiratory failure to lung transplantation.