The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Earlier stage 1 palliation is associated with better clinical outcomes and lower costs for neonates with hypoplastic left heart syndrome.
Our aim was to examine the effects of surgical timing on major morbidity, mortality, and total hospital reimbursement for late preterm and term infants with hypoplastic left heart syndrome (HLHS) undergoing stage 1 palliation within the first 2 weeks of life. ⋯ Delay of stage 1 palliation for neonates with HLHS is associated with increased morbidity and health care costs, even within the first 2 weeks of life.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy: a study of causes and implications.
To study causes and implications of intraoperative conversion to thoracotomy during video-assisted thoracoscopic surgery (VATS) lobectomy. ⋯ With increasing experience, a higher proportion of lobectomy operations can be completed thoracoscopically. VATS should be strongly considered as the initial approach for the majority of patients undergoing lobectomy.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Observational StudyTechnical feasibility and intermediate outcomes of using a handcrafted, area-preserving, bifurcated Y-graft modification of the Fontan procedure.
To demonstrate the technical feasibility and describe intermediate outcomes for the initial patients undergoing handcrafted, area-preserving, Y-graft modification of the Fontan procedure. ⋯ The area-preserving, bifurcated Y-graft Fontan modification is technically feasible and shows excellent intermediate outcomes. Additional study is required to determine whether the advantages seen in the computational models will be realized in patients over the long-term, and to optimize patient selection for each of the various Fontan options now available.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Changing glucose control target and risk of surgical site infection in a Southeast Asian population.
Hyperglycemia is associated with surgical site infection and mortality in cardiac surgical patients. There is overriding evidence that glycemic control improves morbidity and mortality. However, the optimal glucose range in these patients remains controversial. Intensive glucose control can lead to mortality among critically ill adults because of episodic, moderate hypoglycemia. Therefore, we examined the effect of different glucose target control on the incidence of surgical site infection in our prospective cohort of diabetic and nondiabetic patients undergoing coronary artery bypass grafting. ⋯ A target blood glucose of less than 8 mmol/L was associated with a lower incidence of surgical site infection in diabetic patients presenting for elective coronary artery bypass grafting in the local Southeast Asian population.
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J. Thorac. Cardiovasc. Surg. · Jan 2015
Continuous-flow ventricular assist device exchange is safe and effective in prolonging support time in patients with end-stage heart failure.
Although the development of continuous-flow ventricular assist devices (CF-VAD) has improved the reliability of these devices, VAD exchange is still occasionally necessary. The focus of this study was to analyze our institution's entire experience with primary CF-VAD implants, evaluate the baseline variables, determine which factors predict the need for exchange, and evaluate the impact of exchange on survival and event-free survival. ⋯ In our series of contemporary CF-VAD exchanges, a history of previous cerebrovascular events was a significant predictor for exchange. Exchange did not affect early or late survival. Our data suggest that aggressive surgical treatment of pump-related complications with exchange is safe and justified.