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71.
Olivier Chiche Josep Rods‐Cabau Francisco Campelo‐Parada Afonso B. Freitas‐Ferraz Ander Regueiro Chekrallah Chamandi Tania Rodriguez‐Gabella Mlanie Ct Robert DeLarochellire Jean‐Michel Paradis Eric Dumont Daniel Doyle Siamak Mohammadi Sbastien Bergeron Philippe Pibarot Jonathan Beaudoin 《Echocardiography (Mount Kisco, N.Y.)》2019,36(4):722-731
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Elizabeth D. Krebs Robert B. Hawkins J. Hunter Mehaffey Clifford E. Fonner Alan M. Speir Mohammed A. Quader Jeffrey B. Rich Leora T. Yarboro Nicholas R. Teman Gorav Ailawadi 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1533-1542.e2
Objectives
Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.Methods
Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00.Results
A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality.Conclusions
Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight. 相似文献74.
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《Journal of Cardiovascular Computed Tomography》2020,14(5):407-413
BackgroundCT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.Methods44 consecutive patients (mean age: 73 ± 15 years, 57% male) undergoing CTA with subsequent SAPIEN 3 valve insertion for severe bicuspid aortic stenosis (AS) were included. AA was measured at the basal ring. SA was measured by generating a circle defined by the intercommisural distance. AA and SA were measured by 2 independent observers. Baseline characteristics, TAVR procedural data, and discharge echocardiography data were collected.ResultsThe SA was significantly larger than the AA (562 ± 146mm2 vs. 518 ± 112mm2,p = 0.013). Interobserver agreement was high using both techniques (ICC AA = 0.98,p < 0.001; SA = 0.80,p < 0.001), but with narrower limits of agreement with AA measurements (mean difference (limits of agreement): AA = −3mm2 (22; 19), SA = −16mm2 (−92; 76)). AA-based device sizing demonstrated substantial agreement with final valve inserted (κ = 0.72,p < 0.001), while SA demonstrated fair agreement (κ = 0.40,p < 0.001). There was no difference in post TAVR gradients, paravalvular leakage or valve success between patients with concordant sizing between AA and SA, and those in whom SA would have suggested an alternate valve size.ConclusionsSupra-annular sizing is less reproducible than annular sizing, with no difference in procedural complication rates in patients in whom supra-annular sizing would have altered the device size used. These results suggest no role for supra-annular sizing in current clinical practice. 相似文献
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目的采用国产猪胰弹性蛋白酶溶液主动脉周浸泡法构建兔腹主动脉瘤(AAA)模型,并随访其长期稳定性。方法 24只新西兰兔随机分成两组,实验组(n=12)用10μL浓度为10 U/μL国产猪胰弹性蛋白酶溶液浸润主动脉近分叉处血管段30 min,对照组用10μL 0.9%氯化钠溶液浸润30 min。术前和术后5、15、40、100、150 d分别经耳缘静脉造影测量主动脉内径。术后5、15、150 d造影后每组分别处死4只兔作苏木精-伊红(HE)、弹力纤维EVG染色和免疫组化染色。结果实验组术后5 d均形成AAA,主动脉直径100 d内基本稳定,150 d时明显缩小;组织学上术后5 d血管壁严重破坏、结构紊乱,可见红细胞渗出和炎性细胞浸润,弹力纤维和平滑肌细胞明显减少甚至消失,15 d时血管结构规整,可见部分残留弹力纤维,未见炎性细胞,150 d时管腔变窄,内膜过度增生,可见大量平滑肌细胞增生和紊乱的新生弹力纤维。对照组均未见AAA形成,病理学无明显变化。结论国产猪胰弹性蛋白酶溶液浸泡法可诱导兔AAA形成,操作简单、安全、有效。该模型有自愈倾向,但100 d内基本稳定,有助于AAA机制研究。 相似文献
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