The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · May 2009
Matching donor to recipient in lung transplantation: How much does size matter?
The impact of size matching between donor and recipient is unclear in lung transplantation. Therefore, we determined the relation of donor lung size to 1) posttransplant survival and 2) pulmonary function as measured by forced expiratory volume in 1 second. ⋯ Size matching between donor and recipient using predicted total lung capacity ratio and actual total lung capacity ratio is an effective technique. Wide discrepancies in lung sizing do not affect overall posttransplant survival or pulmonary function. Therefore, a greater degree of lung size mismatch can likely be accepted, thereby improving patients' odds of undergoing transplantation.
-
J. Thorac. Cardiovasc. Surg. · May 2009
The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database.
We sought to determine the association between pediatric cardiac surgical volume and mortality using sophisticated case-mix adjustment and a national clinical database. ⋯ There was an inverse association between pediatric cardiac surgical volume and mortality that became increasingly important as case complexity increased. Although volume was not associated with mortality for low-complexity cases, lower-volume programs underperformed larger programs as case complexity increased.
-
J. Thorac. Cardiovasc. Surg. · May 2009
Comparative StudyEnhanced fibrinolysis protects against lung ischemia-reperfusion injury.
Ischemia-reperfusion injury continues to plague the field of lung transplantation, resulting in suboptimal outcomes. In acute lung injury, processes such as ventilator-induced injury, sepsis, or acute respiratory distress syndrome, extravascular fibrin has been shown to promote lung dysfunction and the acute inflammatory response. This study investigates the role of the fibrinolytic cascade in lung ischemia-reperfusion injury and investigates the interplay between the fibrinolytic system and the inflammatory response. ⋯ Lung ischemia-reperfusion injury triggers fibrin deposition in the murine lungs and fibrin creates a proinflammatory environment. Preventing fibrin deposition may reduce ischemia-reperfusion injury and inflammation. This finding may lead to novel treatment strategies for ischemia-reperfusion.
-
J. Thorac. Cardiovasc. Surg. · Apr 2009
Decellularization reduces calcification while improving both durability and 1-year functional results of pulmonary homograft valves in juvenile sheep.
The juvenile sheep functional valve chronic implant calcification model was used to compare long-term calcification rates, functional performance, and durability for 3 types of right ventricular outflow tract implants: classically cryopreserved homografts and 2 decellularized pulmonary valved conduits. ⋯ Cryopreserved-decellularized-glycerolized valves retained normal valve function, with absent leaflet and minimal wall calcifications 1 year postoperatively, as opposed to classically cryopreserved allografts. These results might be predictive of the prolonged durability and functionality of a cryopreserved-decellularized-glycerolized allograft valve.
-
J. Thorac. Cardiovasc. Surg. · Apr 2009
Increased mortality and perioperative complications in patients with previous elective percutaneous coronary interventions undergoing coronary artery bypass surgery.
The relationship between previous percutaneous coronary intervention and perioperative outcome after coronary artery bypass grafting remains undetermined. The aim of the study was to investigate whether previous elective percutaneous coronary intervention influences the outcome of elective coronary artery bypass grafting. ⋯ Patients with a history of elective percutaneous coronary intervention before referral to coronary artery bypass grafting have a worse perioperative outcome in terms of mortality, major adverse cardiac events, and perioperative complications compared with patients without a history of percutaneous coronary intervention. This fact should be considered in risk stratification for patients who are scheduled for elective coronary artery bypass grafting.