The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Randomized Controlled TrialA composite outcome for neonatal cardiac surgery research.
The objective of this study was to determine whether a composite outcome, derived of objective signs of inadequate cardiac output, would be associated with other important measures of outcomes and therefore be an appropriate end point for clinical trials in neonatal cardiac surgery. ⋯ The composite outcome is highly associated with important early operative outcomes and may serve as a useful end point for future clinical research in neonates undergoing cardiac operations.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Multicenter StudyInvasive mechanical ventilation in patients with fibrosing interstitial pneumonia.
The prognosis of patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia undergoing invasive mechanical ventilation (MV) for acute respiratory failure is known to be poor. The issue of life support in these patients needs to be reconsidered in light of changes during the past decade in ventilator settings and in the management of acute exacerbation. We therefore aimed to reassess the prognosis of such patients. ⋯ We confirm that use of invasive MV for acute respiratory failure in patients with idiopathic pulmonary fibrosis or fibrosing idiopathic nonspecific interstitial pneumonia is associated with a high mortality; however, a subset of patients may be discharged alive from the intensive care unit and hospital, providing an opportunity to consider lung transplant in case of eligibility. Our results suggest that invasive MV should not be systematically denied to these patients but discussed on a case-by-case basis.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis.
We examined the characteristics and outcomes of patients requiring valve surgery during active infective endocarditis (IE), focusing on the impact of antimicrobial therapy. ⋯ Surgery for active IE is still associated with a high mortality rate, but its prognosis is significantly improved by adequate antimicrobial therapy.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyShould surgical ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium?
One established predictor for failure of surgical ablation for atrial fibrillation is increased left atrial size. Surgeon perception is that surgical ablation in these patients is ineffective and should not be performed. The purpose of this study was to determine whether a larger left atrial size carries a prohibitive risk for failure and embolic events after surgical ablation. ⋯ The large left atrium group had acceptable return to sinus rhythm and sinus rhythm without antiarrhythmic drugs. The embolic stroke rate was low despite the majority of patients not taking anticoagulation. If patients are managed appropriately post-ablation, left atrial size should not be a discouragement when evaluating surgical candidates with atrial fibrillation.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality.
Optimizing blood pressure using near-infrared spectroscopy monitoring has been suggested to ensure organ perfusion during cardiac surgery. Near-infrared spectroscopy is a reliable surrogate for cerebral blood flow in clinical cerebral autoregulation monitoring and might provide an earlier warning of malperfusion than indicators of cerebral ischemia. We hypothesized that blood pressure below the limits of cerebral autoregulation during cardiopulmonary bypass would be associated with major morbidity and operative mortality after cardiac surgery. ⋯ Blood pressure management during cardiopulmonary bypass using physiologic endpoints such as cerebral autoregulation monitoring might provide a method of optimizing organ perfusion and improving patient outcomes from cardiac surgery.