The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyNatural history of hypercoagulability in patients undergoing coronary revascularization and effect of preoperative myocardial infarction.
The balance between hyper- and hypocoagulable states is critical after coronary artery surgery both with (coronary artery bypass grafting [CABG]) and without (off-pump coronary artery bypass [OPCAB]) cardiopulmonary bypass to prevent thrombotic or bleeding complications. We aimed to quantify novel parameters of coagulation, fibrinolysis, and overall hemostasis ≤6 months after CABG and OPCAB and to determine the influences on these parameters. ⋯ Patients will be vulnerable to thrombotic events for ≤6 weeks after coronary surgery yet will have resolution of hypercoagulability by 6 months. Preoperative factors, such as MI, could require individualized management of thrombosis prophylaxis in the postoperative period.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Comparative StudyRespiratory dynamic magnetic resonance imaging for determining aortic invasion of thoracic neoplasms.
An accurate radiological method for evaluating the presence or extent of aortic invasion by thoracic cancer is essential in the preoperative setting. The aim of this study was to assess whether respiratory dynamic (RD) magnetic resonance imaging (MRI) more accurately detects aortic invasion of mediastinal tumors and lung cancer compared with conventional MRI or computed tomography (CT). ⋯ RD MRI may improve the diagnostic accuracy of MRI by predicting aortic invasion use in preoperative staging.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Observational StudyRate of increase in serum lactate level risk-stratifies infants after surgery for congenital heart disease.
Increased blood lactate levels reflect tissue oxygen debt and might be indicative of low cardiac output. We hypothesized that the rate of increase in serum lactate would be an ideal marker to discriminate between infants at high and low risk of a poor outcome after surgical repair of congenital heart disease using cardiopulmonary bypass. ⋯ The postoperative lactate increase rate allows discrimination between infants at high and low risk of morbidity and mortality after congenital heart disease surgery, and the lactate level can be followed serially for the treatment response.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Observational StudyManagement of concomitant mild to moderate functional mitral regurgitation during aortic valve surgery for severe aortic insufficiency.
The optimal management of mild to moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for severe aortic insufficiency (AI) is poorly defined. We aimed to investigate the fate of FMR after AVR with or without concomitant mitral annuloplasty (MAP) and to identify the risk factors and clinical implications of persistent FMR. ⋯ Mild to moderate FMR as a result of severe AI improved with AVR in most patients with or without concomitant MAP. Poor postoperative LVEDD reduction was the only risk factor for persistent FMR. Because persistent FMR tended to be associated with heart failure events, close echocardiographic monitoring and proactive medical management are recommended in patients showing poor LVEDD reduction after AVR.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
First nationwide survey of US integrated 6-year cardiothoracic surgical residency program directors.
The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. ⋯ High satisfaction rates with the I-6 format were prevalent among I-6 program directors. However, concerns with respect to training relatively less experienced, mature trainees were evident.