The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2016
Mechanical stress is associated with right ventricular response to pulmonary valve replacement in patients with repaired tetralogy of Fallot.
Patients with repaired tetralogy of Fallot account for a substantial proportion of cases with late-onset right ventricular failure. The current surgical approach, which includes pulmonary valve replacement/insertion, has yielded mixed results. Therefore, it may be clinically useful to identify parameters that can be used to predict right ventricular function response to pulmonary valve replacement. ⋯ Computational modeling and right ventricular stress may be used as tools to identify right ventricular function response to pulmonary valve replacement. Large-scale clinical studies are needed to validate these preliminary findings.
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J. Thorac. Cardiovasc. Surg. · Mar 2016
Frequency and outcomes of severe hyperlactatemia after elective cardiac surgery.
Hyperlactatemia is relatively common in the cardiac surgical patient and is usually considered a marker of illness severity. The frequency and impact of severe hyperlactatemia after elective cardiac surgery has not been described, and prognosis may be different compared with that for other surgical or medical critically ill patient populations. ⋯ Severe postoperative hyperlactatemia is rare after elective cardiac surgery. Although this phenomenon continues to be associated with mortality, >50% of patients survived to hospital discharge, a more favorable prognosis, compared with other patient populations based on lactate levels alone. Important exceptions were patients who had extremity compartment syndrome or mesenteric ischemia, which were associated with in-hospital death in all cases. In all other etiologic groups, a substantial proportion of patients were discharged to home.
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J. Thorac. Cardiovasc. Surg. · Mar 2016
WebcastsPulmonary vein stenosis: Severity and location predict survival after surgical repair.
Pulmonary vein characteristics that influence survival after repair of stenosis have not been defined. We sought to develop a predictive model relating postrepair survival to preoperative pulmonary vein characteristics on computed tomography and magnetic resonance imaging. ⋯ Smaller upstream or downstream total cross-sectional area indexed for body surface area negatively influenced survival. Early survival seemed especially poor for patients with a greater number of stenotic veins and upstream pulmonary vein involvement. The total cross-sectional area indexed for body surface area measurements can help to inform prognosis and stratify patients for enrollment in clinical trials of agents directed at pulmonary vein pathology.
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J. Thorac. Cardiovasc. Surg. · Mar 2016
Remote ischemic preconditioning protects the spinal cord against ischemic insult: An experimental study in a porcine model.
Surgical repair of thoracoabdominal aneurysm jeopardizes the vascularization of the spinal cord, and therefore, despite improvement in surgical techniques, still carries the risk of paraplegia. This study aimed to demonstrate the possible protective effects of remote ischemic preconditioning (RIPC) on the preservation of spinal cord function after segmental artery (SA) occlusion. ⋯ Remote ischemic preconditioning preserves spinal cord function after left subclavian artery and SA occlusion, as indicated by the MEP amplitudes.