The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Randomized Controlled TrialHemostatic effects of fibrinogen concentrate compared with cryoprecipitate in children after cardiac surgery: a randomized pilot trial.
Acute acquired hypofibrinogenemia in children undergoing cardiac surgery is a major concern because it often results in perioperative bleeding and high rates of allogeneic blood transfusion. Fibrinogen concentrate has been proposed as an alternative to cryoprecipitate (the gold standard therapy), with minimal infectious and immunologic risks. Our objective was to investigate the efficacy and safety of fibrinogen concentrate in children undergoing cardiac surgery. ⋯ A large trial comparing fibrinogen concentrate and cryoprecipitate in the management of children with acute acquired hypofibrinogenemia during heart surgery is feasible. The preliminary results of our study showed that the use of fibrinogen concentrate was as efficient and safe as cryoprecipitate in the management of bleeding children undergoing cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Randomized Controlled TrialCoronary artery bypass in patients with type 2 diabetes: experience from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.
Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) was a study of management strategies for diabetic patients with myocardial ischemia and coronary artery disease. In a 2×2 design, early revascularization versus medical management with or without late revascularization and insulin sensitization versus insulin provision were examined. No advantage for either strategy was seen, except in the group undergoing early coronary artery bypass grafting (CABG). In that group, a reduction in subsequent myocardial infarction was noted. The purpose of our report was to characterize the conduct and short-term outcomes for CABG that led to this result. ⋯ BARI 2D showed that early CABG in patients with type 2 diabetes and myocardial ischemia and multivessel disease reduced the subsequent myocardial infarction rates. The present results have demonstrated that this was achieved using off-pump surgery in certain cases, standard myocardial protection, and routine use of the internal mammary artery or other arterial grafts.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter Study Observational StudyCompleteness of coronary revascularization and survival: Impact of age and off-pump surgery.
We conducted a multicenter observational cohort study of the effect of completeness of revascularization on long-term survival after coronary artery bypass grafting. We also investigated the impact of age and off-pump surgery. ⋯ Incomplete revascularization is associated with decreased long-term survival, even in elderly patients. Surgeons should consider these findings when choosing a revascularization strategy, particularly if off-pump coronary artery bypass grafting is contemplated.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter StudyPractice patterns of academic general thoracic and adult cardiac surgeons.
We hypothesized that academic adult cardiac surgeons (CSs) and general thoracic surgeons (GTSs) would have distinct practice patterns of, not just case-mix, but also time devoted to outpatient care, involvement in critical care, and work relative value unit (wRVU) generation for the procedures they perform. ⋯ Academic CSs and GTSs have distinct practice patterns. CSs receive greater reimbursement for services because of the greater wRVUs of the procedures performed compared with GTSs, and evaluation and management coding is a more important wRVU generator for GTSs. The results of our study could guide academic CS and GTS practice structure and time prioritization.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Comparative StudyClinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases.
We compared the clinical outcomes and changes in pulmonary function test (PFT) results after segmentectomy or lobectomy for non-small cell lung cancer. ⋯ Both surgical types were safe. We would advocate lobectomy for patients with stage IA disease, especially those with T1b. A retrospective study with a large sample size and more detailed information should be conducted for PFT evaluation, with additional stratification by lobe and laterality.