What happens to the thymus in children who have undergone a median sternotomy?

MacDonald, Kelly S.; Mackenzie, Stephanie

doi:10.1007/s00247-009-1202-0

Cited by 5 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a case–control pediatric study, 29% of children with sternotomy after cardiac surgery had an identifiable thymus on 14-month magnetic resonance image compared to 92% in the control group who had no cardiac surgery. The authors suggested that postoperative residual thymic tissue does not regenerate [22]. Additionally, in a study that included pediatric and adult populations, cardiothoracic surgery and incidental thymectomy were associated with immune dysregulation and unclear factors that altered the regulatory T cells [23].…”

Section: Discussionmentioning

confidence: 99%

Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy

Azab

Shariff

Bachir

et al. 2013

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundNeutrophil lymphocyte ratio (NLR) is a predictor of major adverse cardiovascular outcomes. Our study explores the value of NLR in predicting long-term mortality after minimally invasive coronary artery bypass surgery (MICS) via lateral left-thoracotomy versus conventional sternotomy coronary artery bypass grafting (CABG) surgery.MethodsA total of 1126 consecutive patients (729 sternotomy CABG and 397 MICS) from a single tertiary center between 2005 and 2008 were followed until 2011. We stratified the patients into equal tertiles according to preoperative NLR. The primary outcome, all-cause mortality, was compared among the NLR tertiles.ResultsOut of the 1126 patients included in the study, 1030 (91%) patients underwent off-pump CABG . The first (NLR <2.3) tertile had a significantly lower 5-year mortality (30/371 =8%) in comparison to the second (NLR =2.3-3.4) and third (NLR ≥3.5) tertiles (49/375 =13% and 75/380 =20%), respectively with p < 0.0001. After multivariate adjustment, NLR was a significant independent predictor of mortality (hazard ratio [HR] per each unit increase of NLR was 1.05, 95% confidence interval [CI] 1.01-1.10, p = 0.008). MICS and sternotomy CABG groups with NLR <3 had similar mortality (21/221 =9.5% and 40/403 =9.9%), p = 1. However among patients with NLR ≥3, MICS had a significantly lower mortality (23/176 = 13.1%) compared to the sternotomy CABG (70/326 =21.5%), p = 0.02. According to the multivariate analysis of patients with NLR ≥3, MICS had a significantly lower mortality compared to sternotomy CABG (HR = 0.44, 95% CI 0.24-0.78, p = 0.005).ConclusionElevated preoperative NLR is an independent predictor of long-term mortality after CABG. Among the patients with NLR ≥ 3, MICS was associated with a significantly improved survival compared with sternotomy CABG.

show abstract

Section: Discussionmentioning

confidence: 99%

Elevated preoperative neutrophil/lymphocyte ratio as a predictor of increased long-term survival in minimal invasive coronary artery bypass surgery compared to sternotomy

Azab

Shariff

Bachir

et al. 2013

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…3,4 Altered immune profiles in patients undergoing thymectomy have been consistent with extrathymic production, 5,6 but thymic remnants usually do not persist or regenerate in the mediastinum in humans. 7 Because the human thymus is considered mature at birth and regresses with age, it may not be essential to immune function after birth.…”

Section: Introductionmentioning

confidence: 99%