The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Editorial ReviewContemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence.
Extracorporeal membrane oxygenation (ECMO) provides days to weeks of support for patients with respiratory, cardiac, or combined cardiopulmonary failure. Since ECMO was first reported in 1974, nearly 70,000 runs of ECMO have been implemented, and the use of ECMO in adults increased by more than 400% from 2006 to 2011 in the United States. A variety of factors, including the 2009 influenza A epidemic, results from recent clinical trials, and improvements in ECMO technology, have motivated this increased use in adults. Because ECMO is increasingly becoming available to a diverse population of critically ill patients, we provide an overview of its fundamental principles and a systematic review of the evidence basis of this treatment modality for a variety of indications in adults.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Bilateral internal thoracic artery grafting: Does graft configuration affect outcome?
Despite evidence that bilateral internal thoracic arteries (ITAs) improve long-term survival after coronary artery bypass grafting (CABG), uptake of this technique remains low. We directly compared bilateral ITA graft configurations and examined long-term outcomes. ⋯ Bilateral ITA graft configuration has no independent effect on need for repeat revascularization or long-term survival. Therefore, the simplest technique, determined by individual patient characteristics, should be selected.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
The risk and extent of neurologic events are equivalent for high-risk patients treated with transcatheter or surgical aortic valve replacement.
This study was designed to characterize the incidence of new clinically detectable neurologic events, or any comparative change in indices of higher cognitive function following transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) within the framework of a prospective, randomized clinical trial for high-risk patients. ⋯ This study defines an equivalent postprocedural stroke risk, stroke extent, and degree of cognitive change after TAVR or SAVR in a high-risk population, and also defines several predictors of stroke after TAVR.