The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Time in therapeutic range and risk of thromboembolism and bleeding in patients with a mechanical heart valve prosthesis.
Oral anticoagulation with vitamin K antagonists is recommended after mechanical heart valve replacement. However, data regarding the association between the quality of vitamin K antagonist treatment and the risk of complications are sparse. ⋯ In patients undergoing mechanical heart valve replacement, TTR <70% in the 6-month period after surgery was associated with an increased risk of thromboembolic events but not bleeding compared with TTR ≥70%.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Association of earlier extubation and postoperative delirium after coronary artery bypass grafting.
Earlier extubation after cardiac surgery is reported to have benefits on length of stay and complication rates, but the influence on postoperative delirium remains unclear. We sought to determine the effect of earlier extubation on delirium after coronary artery bypass grafting. ⋯ Our findings suggest that delirium rates increase with lengthier postoperative ventilation times. This study provides the basis for consideration of the appropriate selection of earlier extubation to minimize delirium in patients undergoing cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Prenatal hypoxemia alters microglial morphology in fetal sheep.
Neuroimmune cells, particularly microglia and astrocytes, play a critical role in neurodevelopment. Neurocognitive delays are common in children with congenital heart disease, but their etiology is poorly understood. Our objective was to determine whether prenatal hypoxemia, at levels common in congenital heart disease, induced neuroimmune activation to better understand the origins of neurobehavioral disorders in congenital heart disease. ⋯ Prenatal hypoxemia altered microglial morphology without significant gliosis. Additional studies characterizing these mechanisms may provide insight into the origins of neurobehavioral disabilities in children with congenital heart disease.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Inhibition of long noncoding RNA growth arrest-specific 5 attenuates cerebral injury induced by deep hypothermic circulatory arrest in rats.
We sought to investigate cerebroprotection by targeting long noncoding RNA growth arrest-specific 5 in a rat model of prolonged deep hypothermic circulatory arrest. ⋯ Inhibition of large noncoding RNA growth arrest-specific 5 can provide a powerful cerebroprotection against deep hypothermic circulatory arrest, which may be mediated through microRNA-23a/phosphate and tension homology pathway.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Cardiothoracic surgery training in South Korea: Challenges and new hopes.
In this era when multiple challenges are surrounding the cardiothoracic surgery specialty, including an increase in procedural complexity and institutionalization of public reporting, it is rather paradoxical to have an unprecedentedly unfavorable condition for quality education while the level of proficiency and competency to be achieved during the course of training became more demanding. Cardiothoracic surgery in South Korea is also facing several challenges across multiple levels that includes a persistent low filling rate of residency positions, severe therapeutic deviation toward percutaneous transcatheter intervention in coronary artery disease, a social climate reluctant to cardiovascular surgery and consequent underestimation of surgical volume, and skewed health insurance reimbursement system. Meanwhile, some hopeful signs have been observed in our specialty because of ongoing efforts of our leaderships of the Society, including recent financial initiative and several educational platforms such as boot camp. We introduce our system internationally to share our experience for the purpose of promoting further discussions and encouraging persistent efforts toward education.