The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2015
Comparative StudyCoronary artery bypass grafting in diabetics: A growing health care cost crisis.
To determine 4-decade temporal trends in the prevalence of diabetes and cardiovascular risk factors among patients undergoing coronary artery bypass grafting (CABG) and to compare in-hospital outcomes, resource utilization, and long-term survival after CABG in diabetics versus nondiabetics. ⋯ Diabetes is both a marker for high-risk, resource-intensive, and expensive care after CABG and an independent risk factor for reduced long-term survival. These issues, coupled with the increasing proportion of patients needing CABG who have diabetes, are a growing challenge in reining in health care costs.
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J. Thorac. Cardiovasc. Surg. · Aug 2015
In vitro hemodynamic characterization of HeartMate II at 6000 rpm: Implications for weaning and recovery.
Pump-off testing to assess left ventricular recovery is not an option for continuous-flow left ventricular assist devices unless measures are taken to prevent pump regurgitation. The purpose of this bench study was to characterize the hemodynamics and pump flow of the HeartMate II (Thoratec Corp, Pleasanton, Calif) left ventricular assist device at 6000 rpm, the speed commonly used clinically to determine left ventricular recovery. ⋯ The net pump flow generated by the HeartMate II device at 6000 rpm depends on the degree of residual left ventricular function. In the setting of improved left ventricular function, at 6000 rpm, we noted a large regurgitant flow that reloaded the left ventricle. Although this "marker" can serve as a useful indicator for left ventricular recovery, assessing left ventricular recovery at this speed is flawed unless measures are taken to prevent regurgitant flow.
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J. Thorac. Cardiovasc. Surg. · Aug 2015
Comparative StudyOff-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease.
We compared the outcomes in propensity score-matched patients who had chronic kidney disease (CKD) undergoing off-pump coronary bypass grafting, with either a bilateral or single skeletonized internal thoracic artery (ITA). ⋯ In patients who have CKD, off-pump, skeletonized, left-side bilateral ITA grafting is associated with lower risk of all-cause and cardiac-related mortality, and does not increase operative risk.