The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2019
Preoperative β-blocker use correlates with worse outcomes in patients undergoing aortic valve replacement.
β-Blocker use is associated with fewer cardiac complications in patients undergoing noncardiac surgery and is a quality metric for coronary artery bypass grafting. We sought to determine the influence of preoperative β-blocker administration before aortic valve replacement (AVR). ⋯ Preoperative β-blocker administration is not associated with improved outcomes after AVR but instead is associated with increased postoperative morbidity. Routinely initiating preoperative β-blockade is not supported in patients undergoing AVR.
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J. Thorac. Cardiovasc. Surg. · Dec 2019
Comparative StudyOutcomes of surgery versus chemoradiotherapy in patients with clinical or pathologic stage N3 non-small cell lung cancer.
Because surgery is rarely recommended, there is minimal literature comparing the outcomes of surgery and chemoradiation in stage N3 non-small cell lung cancer (NSCLC). We examined the outcomes of definitive chemoradiation versus multimodality therapy, including surgery, for patients with clinical and pathologic stage N3 NSCLC. ⋯ In patients with clinical or pathologic stage N3 NSCLC, surgery is associated with similar or worse short-term but improved long-term survival compared with chemoradiation. In a selected group of patients with stage N3 NSCLC, surgery may have a role in multimodal therapy.
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J. Thorac. Cardiovasc. Surg. · Dec 2019
Time for evidence-based, standardized donor size matching for pediatric heart transplantation.
Accurately predicting cardiac size by other body parameters has long been problematic to determine whether a donor heart will serve a given waitlist candidate, yet hundreds of heart donors are turned down annually for size mismatch. ⋯ Despite substantial practice variation in acceptable donor weight in pediatric heart transplantation, patients listed with variable DCW had similar posttransplant survival. However, in critically ill patients, higher DCW was associated with greater waitlist survival. Better understanding of the importance of donor weight could reduce practice variability and improve organ use and waitlist outcomes for pediatric cardiac transplant candidates.
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J. Thorac. Cardiovasc. Surg. · Dec 2019
Extracorporeal membrane oxygenation for primary graft dysfunction after heart transplant.
Venoarterial extracorporeal membrane oxygenation is a useful treatment for severe primary graft dysfunction after heart transplant. The ideal timing of initiation is unknown. ⋯ Prompt venoarterial extracorporeal membrane oxygenation use for primary graft dysfunction after heart transplant results in excellent myocardial recovery and a possible decrease in mortality without increased risk of complications.