The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Multicenter StudyAssociation of cardiac biomarkers with acute kidney injury after cardiac surgery: A multicenter cohort study.
Acute kidney injury is common after cardiac surgery and associated with postoperative mortality. Perioperative cardiac biomarkers may predict acute kidney injury and mortality. We evaluated whether cardiac biomarkers were associated with severe acute kidney injury, defined as a doubling in serum creatinine or requiring renal replacement therapy during hospital stay after surgery, and mortality. ⋯ Of the studied biomarkers, N-terminal prohormone of brain natriuretic peptide was the only preoperative biomarker independently associated with severe acute kidney injury and mortality. Early increases in postoperative cardiac biomarkers were associated with severe acute kidney injury after cardiac surgery. Future research should focus on whether interventions that lower N-terminal prohormone of brain natriuretic peptide can affect postoperative outcomes.
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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
Randomized Controlled Trial Multicenter StudyPedicled and skeletonized single and bilateral internal thoracic artery grafts and the incidence of sternal wound complications: Insights from the Arterial Revascularization Trial.
The question of whether skeletonized internal thoracic artery harvesting reduces the incidence of sternal wound complications in comparison with the pedicled technique, in the context of single or bilateral internal thoracic arteries, remains controversial. We studied the impact of the internal thoracic artery harvesting strategy on sternal wound complication in the Arterial Revascularization Trial. ⋯ The present Arterial Revascularization Trial substudy suggests that, with a skeletonization technique, the risk of sternal wound complication with bilateral internal thoracic artery grafting is similar to that after standard pedicled single internal thoracic artery harvesting, whereas skeletonized single internal thoracic artery harvesting did not add any further benefit when compared with pedicled single internal thoracic artery harvesting.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
The predictive value of s-cystatin C for mortality after coronary artery bypass surgery.
To evaluate serum creatinine (s-creatinine) and serum cystatin C (s-cystatin C) levels and estimated glomerular filtration rate (eGFR) at different time points as predictors for mortality in patients undergoing coronary artery bypass grafting (CABG). ⋯ The s-cystatin C level and s-cystatin C-based eGFR measured preoperatively are strong predictors for mortality after elective CABG.
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J. Thorac. Cardiovasc. Surg. · Jul 2016
Multicenter StudyThe effect of coronary angiography timing and use of cardiopulmonary bypass on acute kidney injury after coronary artery bypass graft surgery.
Acute kidney injury is a common but serious complication of coronary artery bypass grafting. We investigated whether the effect of the timing of coronary angiography on acute kidney injury after coronary artery bypass grafting is influenced by the use of cardiopulmonary bypass. ⋯ A shorter interval between coronary angiography and surgery influenced the occurrence of acute kidney injury in patients undergoing on-pump coronary artery bypass. However, the interval is not an independent risk factor for the development of postoperative acute kidney injury in patients who undergo off-pump coronary artery bypass.