The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Syndecan-1 improves severe acute kidney injury prediction after pediatric cardiac surgery.
Acute kidney injury is a common occurrence after pediatric cardiac surgery and is associated with adverse patient outcomes. Syndecan-1 is a biomarker of endothelial glycocalyx damage, and its early increment after surgery can be associated with acute kidney injury. ⋯ Postoperative plasma syndecan-1 is associated with subsequent severe acute kidney injury and poor outcomes among children undergoing cardiac surgery. It may be useful to identify patients who are at increased risk for acute kidney injury after cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Observational StudyPrediction of imminent, severe deterioration of children with parallel circulations using real-time processing of physiologic data.
Sudden death is common in patients with hypoplastic left heart syndrome and comparable lesions with parallel systemic and pulmonary circulation from a common ventricular chamber. It is hypothesized that unforeseen acute deterioration is preceded by subtle changes in physiologic dynamics before overt clinical extremis. Our objective was to develop a computer algorithm to automatically recognize precursors to deterioration in real-time, providing an early warning to care staff. ⋯ Automated, intelligent analysis of standard physiologic data in real-time can detect signs of clinical deterioration too subtle for the clinician to observe without the aid of a computer. This metric may serve as an early warning indicator of critical deterioration in patients with parallel systemic and pulmonary circulation.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Pulmonary metastasectomy for suspected pancreaticobiliary cancer.
Occasionally, pancreaticobiliary cancer presents as a relatively indolent disease and localized blood-borne lung metastases may be resectable. We reviewed our experience with therapeutic lung resections in pancreatic cancer patients. ⋯ Although pancreaticobiliary cancers have an overall dismal prognosis, we recommend pulmonary metastasectomy in highly selected patients. Additionally, not all new lung masses in pancreatic cancer patients are metastases, and resection should be considered, for a second primary lung cancer is often found.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Results of a hybrid procedure for patients with proximal left subclavian artery stenosis and coronary artery disease.
To assess whether a hybrid approach to the treatment of coronary artery disease with proximal left subclavian artery stenosis is superior to a staged approach. ⋯ The hybrid procedure of PTA and stenting followed by coronary artery bypass grafting may be an effective approach for patients with concomitant proximal left subclavian artery stenosis and coronary artery disease.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Comparative StudyThe rise of new technologies for aortic valve stenosis: A comparison of sutureless and transcatheter aortic valve implantation.
Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (SU-AVR) are suitable alternatives to conventional surgery. The aim of this study is to compare early outcomes of patients undergoing TAVI and SU-AVR. ⋯ SU-AVR is associated with better device success and a lower incidence of PVL, compared with TAVI. Nevertheless, patients treated with SU-AVR were more likely to receive a permanent pacemaker. SU-AVR and TAVI provide good results in patients who have severe symptomatic aortic valve stenosis. Given the multiple therapeutic options available, patients may receive the treatment that is most appropriate for their clinical and anatomical characteristics.