The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2017
Massive donor transfusion potentially increases recipient mortality after lung transplantation.
Donor blood transfusion has been identified as a potential risk factor for primary graft dysfunction and by extension early mortality. We sought to define the contributing risk of donor transfusion on early mortality for lung transplant. ⋯ Massive donor blood transfusion (>10 units) was associated with early recipient mortality after lung transplantation. Conversely, submassive donor transfusion was not associated with increased recipient mortality. The mechanism of increased early mortality in recipients of lungs from massively transfused donors is unclear and needs further study but is consistent with excess mortality seen with primary graft dysfunction in the first 90 days posttransplant.
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J. Thorac. Cardiovasc. Surg. · May 2017
Video-assisted thoracoscopic diaphragm plication using a running suture technique is durable and effective.
Surgeons have hesitated to adopt minimally invasive diaphragm plication techniques because of technical limitations rendering the procedure cumbersome or leading to early failure or reduced efficacy. We sought to demonstrate efficacy and durability of our thoracoscopic plication technique using a single running suture. ⋯ Thoracoscopic diaphragm plication with a running suture is safe and achieves excellent early and long-term improvements. This addresses technical challenges of tying multiple interrupted sutures by video-assisted thoracoscopic surgery without any apparent compromise to efficacy or durability.
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J. Thorac. Cardiovasc. Surg. · May 2017
Multicenter Study Observational StudyTotal and free cortisol responses and their relation to outcomes after cardiopulmonary bypass in infants.
Hypothalamic-pituitary-adrenal (HPA) axis dysfunction may be partially responsible for the hemodynamic instability experienced by infants after cardiopulmonary bypass (CPB). We report the full spectrum of the HPA response surrounding CPB for infant congenital cardiac surgery. ⋯ We observed a significant decline in all aspects of the HPA axis throughout the first 24 hours after infant CPB. TC and FC levels were not associated with clinical outcomes. Subnormal (Δ <9 μg/dL) TC response to cosyntropin stimulation during the postoperative period was associated with increased fluid resuscitation and greater LOS.
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J. Thorac. Cardiovasc. Surg. · May 2017
Comparative StudyVariable selection methods for multiple regressions influence the parsimony of risk prediction models for cardiac surgery.
To compare the impact of different variable selection methods in multiple regression to develop a parsimonious model for predicting postoperative outcomes of patients undergoing cardiac surgery. ⋯ Clinical suitability in terms of parsimony and prediction performance can be achieved substantially by using the bootstrap ROC method for the development of risk prediction models.
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J. Thorac. Cardiovasc. Surg. · May 2017
Multicenter Study Observational StudyRemodeling root repair with an external aortic ring annuloplasty.
Although the remodeling technique provides the most dynamic valve-sparing root replacement, a dilated annulus (>25 mm) is a risk factor for failure. Aortic annuloplasty aims to reduce the annulus diameter, thus increasing coaptation height to protect the repair. The results of 177 patients with remodeling and external aortic ring annuloplasty were studied. ⋯ The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.