The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2014
Modified in vivo lung perfusion allows for prolonged perfusion without acute lung injury.
In vivo lung perfusion (IVLP) is an emergent strategy to treat lung metastases because it allows localized delivery of chemotherapy with minimal systemic exposure. Previously, short-term (± 30 minutes) IVLP resulted in variable efficacy and significant lung toxicity. We hypothesize that a modified IVLP strategy derived from an ex vivo lung perfusion technique could minimize lung injury. Our objective was to demonstrate the feasibility and safety of a modified prolonged (4 hours) IVLP. ⋯ Four hours of IVLP is feasible without adding significant lung injury. Prolonged perfusion time and a protective protocol might provide safer and more efficacious treatment of pulmonary metastases.
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J. Thorac. Cardiovasc. Surg. · Feb 2014
Comparative StudyIncidence, dynamics, and prognostic value of acute kidney injury for death after cardiac surgery.
This study relates long-term mortality after cardiac surgery to different methods of measuring postoperative renal function, classified according to the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. The dynamics of acute kidney injury during hospital stay were studied by comparing renal function preoperatively, at its poorest measurement, and at discharge. ⋯ Classification using RIFLE criteria seems to be useful because it detects patients with renal impairment that affects long-term survival. The Modification of Diet in Renal Disease method seems to be the most robust method when predicting outcome, and the poorest renal function was the best predictor of outcome. Renal recovery was generally associated with better outcome.
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J. Thorac. Cardiovasc. Surg. · Feb 2014
Prognostic predictors in pericardiectomy for chronic constrictive pericarditis.
Prognosis after pericardiectomy remains to be clearly elucidated, especially in Asian countries, where the causes of constrictive pericarditis differ from those in Western countries. We aimed to investigate the preoperative prognostic factors and clinical outcomes after pericardiectomy in patients with chronic constrictive pericarditis. ⋯ Preoperative high early diastolic mitral inflow velocity and diabetes mellitus were predictors of poor prognosis after pericardiectomy in patients with chronic constrictive pericarditis. These results suggest that preoperative Doppler echocardiographic evaluation may be valuable not only for diagnosing constrictive pericarditis but also for predicting prognosis after pericardiectomy.
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J. Thorac. Cardiovasc. Surg. · Feb 2014
Bilateral pulmonary arterial banding results in an increased need for subsequent pulmonary artery interventions.
Despite increasing use of bilateral branch pulmonary artery banding (bPAB), both as a temporary stabilizing treatment and as part of comprehensive hybrid management of hypoplastic left heart syndrome, little is known about the long-term outcomes of the pulmonary arteries (PAs) in banded patients. ⋯ Patients with bPAB require additional interventions at earlier time points than Norwood patients. Patients with smaller bands and longer duration of banding are at high risk. Despite stenoses requiring additional interventions, Fontan candidacy is maintained.
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J. Thorac. Cardiovasc. Surg. · Feb 2014
Repair of posterior mitral valve prolapse with a novel leaflet plication clip in an animal model.
Recently, there has been increased interest in minimally invasive mitral valve prolapse repair techniques; however, these techniques have limitations. A new technique was developed for treating mitral valve prolapse that uses a novel leaflet plication clip to selectively plicate the prolapsed leaflet segment. The clip's efficacy was tested in an animal model. ⋯ The leaflet plication clip can treat mitral valve prolapse in an animal model, restoring coaptation height without affecting leaflet mobility. This approach is a simple technique that may improve the effectiveness of beating-heart and minimally invasive valve surgery.