The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2017
Cerebral near-infrared spectroscopy insensitively detects low cerebral venous oxygen saturations after stage 1 palliation.
Measurement of cerebral venous oxyhemoglobin saturation (ScvO2) is considered a gold standard in assessing the adequacy of tissue oxygen delivery (DO2) after the stage 1 palliation (S1P), with SvO2 <30% often representing severely compromised DO2. Regional oxygenation index (rSO2) based on near-infrared resonance spectroscopy (NIRS) frequently is used to screen for compromised DO2, although its sensitivity to detect severe abnormalities in SvO2 is uncertain. ⋯ Cerebral rSO2 in isolation should not be used to detect low ScvO2, because its sensitivity is low, although correction of rSO2 for arterial contamination may improve sensitivity. Cerebral rSO2 of 50 or greater should not be considered reassuring, though values below 30 are specific for low ScvO2.
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J. Thorac. Cardiovasc. Surg. · Sep 2017
Early and late outcomes with prolonged open chest management after cardiac surgery.
Open chest management (OCM) is an important intervention for patients who are unable to undergo sternal closure after cardiac surgery. This study reviews the factors associated with a prolonged need for this intervention and investigates its association with early and late mortality. ⋯ Prolonged OCM was associated with increasing perioperative morbidity and a higher risk of early and late mortality.
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J. Thorac. Cardiovasc. Surg. · Sep 2017
Clinical outcomes following self-expanding metal stent placement for esophageal salvage.
To assess the efficacy of self-expanding metal stents (SEMS) for esophageal salvage in patients who would otherwise require esophageal/conduit resection. ⋯ Our study demonstrates the successful use of SEMS in patients with anastomotic leaks, perforations, and recalcitrant strictures.
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J. Thorac. Cardiovasc. Surg. · Sep 2017
Treatment of stage I non-small cell lung cancer: What's trending?
Stage I non-small cell lung cancer traditionally is treated with lobectomy. Sublobar resection and stereotactic body radiation therapy provide alternative treatments for higher-risk groups. The purpose of this study was to determine the national treatment trends for stage I lung cancer. ⋯ Although the number of stage I non-small cell lung cancer cases continues to increase, lobectomy rates are decreasing while sublobar resection and stereotactic body radiation therapy rates are increasing. Although the increasing popularity of alternative therapies to lobectomy for treatment of stage I non-small cell lung cancer should allow more patients to undergo treatment, we did not observe this trend in the data.
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J. Thorac. Cardiovasc. Surg. · Sep 2017
CommentEndoscopy after esophagectomy: Safety demonstrated in a porcine model.
Endoscopy is useful in assessing conduit ischemia and anastomotic leaks after esophagectomy but poses a theoretical threat of anastomotic disruption. We used a porcine model to evaluate the safety of endoscopy after esophagectomy. ⋯ Endoscopy after esophagectomy with gentle or maximal air insufflation results in safe endoluminal pressures and minimal disturbance of blood flow and oxygenation.