The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Does the degree of preoperative mitral regurgitation predict survival or the need for mitral valve repair or replacement in patients with anomalous origin of the left coronary artery from the pulmonary artery?
Anomalous origin of the left coronary artery from the pulmonary artery causes severe myocardial ischemia, global left ventricular dysfunction, and annular dilatation producing varying degrees of mitral regurgitation. Mitral regurgitation secondary to the left ventricular or papillary muscle dysfunction in infants will usually improve in the absence of ongoing ischemia. The aim of this study is to determine the influence of the degree of preoperative mitral regurgitation on the early and late outcomes of patients with anomalous origin of the left coronary artery from the pulmonary artery who underwent coronary reimplantation. ⋯ Long-term clinical outcome and left ventricular function are good despite severe left ventricular dysfunction at presentation. Mitral valve repair or replacement is generally not necessary at the time of anomalous origin of the left coronary artery from the pulmonary artery repair. Significant residual mitral regurgitation is present in some patients and can usually be managed surgically at a later date depending on its degree of severity.
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Difficulties encountered managing nodules detected during a computed tomography lung cancer screening program.
The main challenge of screening a healthy population with low-dose computed tomography is to balance the excessive use of diagnostic procedures with the risk of delayed cancer detection. We evaluated the pitfalls, difficulties, and sources of mistakes in the management of lung nodules detected in volunteers in the Cosmos single-center screening trial. ⋯ Low-dose computed tomography screening is effective for the early detection of lung cancers, but nodule management remains a challenge. Computed tomography-positron emission tomography is useful at baseline, but its sensitivity decreases significantly the subsequent year. Multidisciplinary management and experience are crucial for minimizing misdiagnoses.
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Comparative StudyEarly and long-term outcomes in the elderly: comparison between off-pump and on-pump techniques in 1191 patients undergoing coronary artery bypass grafting.
The aim of the present study was to investigate the influence of off-pump coronary artery bypass grafting on early and long-term mortality and morbidity in a consecutive series of elderly patients (aged > 65 years) compared with conventional coronary artery bypass grafting. ⋯ Our analysis shows that off-pump coronary artery bypass grafting compared with conventional coronary artery bypass grafting was associated with favorable early outcomes in the elderly population. However, the early benefits of off-pump coronary artery bypass grafting were not maintained in the long term, and off-pump coronary artery bypass grafting showed trends toward worse long-term results.
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J. Thorac. Cardiovasc. Surg. · Sep 2008
Elevated preoperative hemoglobin A1c level is predictive of adverse events after coronary artery bypass surgery.
Diabetes mellitus has been associated with an increased risk of adverse outcomes after coronary artery bypass grafting. Hemoglobin A1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. ⋯ Elevated hemoglobin A1c level was strongly associated with adverse events after coronary artery bypass grafting. Preoperative hemoglobin A1c testing may allow for more accurate risk stratification in patients undergoing coronary artery bypass grafting.