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Annals of Thoracic Surgery

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https://www.readbyqxmd.com/read/28870391/determinants-of-adverse-outcomes-after-systemic-to-pulmonary-shunts-in-biventricular-circulation
#1
Ben Hobbes, Yves d'Udekem, Diana Zannino, Igor E Konstantinov, Christian Brizard, Johann Brink
BACKGROUND: Systemic-to-pulmonary shunts are useful palliative procedures, although many teams have been deterred by high mortality and morbidity. We aimed to identify predictors of adverse outcomes after shunts in biventricular lesions. METHODS: From 2004 to 2014, 173 children had shunt procedures. Morphologies included: tetralogy of Fallot, pulmonary atresia with ventricular septal defect (VSD) with and without major aortopulmonary collaterals (MAPCAs), transposition of great arteries with pulmonary stenosis, and double outlet right ventricle...
September 1, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28859926/impact-of-accurate-30-day-status-on-operative-mortality-wanted-dead-or-alive-not-unknown
#2
W Steves Ring, James R Edgerton, Morley Herbert, Syma Prince, Cathy Knoff, Kristin M Jenkins, Michael E Jessen, Baron L Hamman
BACKGROUND: Risk-adjusted operative mortality is the most important quality metric in cardiac surgery for determining The Society of Thoracic Surgeons (STS) Composite Score for star ratings. Accurate 30-day status is required to determine STS operative mortality. The goal of this study was to determine the effect of unknown or missing 30-day status on risk-adjusted operative mortality in a regional STS Adult Cardiac Surgery Database cooperative and demonstrate the ability to correct these deficiencies by matching with an administrative database...
August 28, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28847540/a-challenging-treatment-for-aortic-arch-aneurysm-with-fenestrated-stent-graft
#3
Koichi Yuri, Naoyuki Kimura, Daijiro Hori, Atsushi Yamaguchi, Hideo Adachi
BACKGROUND: The endovascular stent graft is a novel therapeutic technique that is used in the treatment of aortic aneurysms. However, the aortic arch is a still an area that requires endovascular repair. Since 2008, the authors have treated aortic arch aneurysms (AAA) in patients without an extraanatomical bypass using a fenestrated stent graft (FSG). This study aimed to evaluate the early outcomes of FSG treatment. METHODS: The authors retrospectively investigated the early outcomes of 54 AAA cases that were performed in their department from January 2008 to May 2016...
August 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28847539/surgical-management-of-esophageal-epiphrenic-diverticula-a-transthoracic-approach-over-four-decades
#4
Luis F Tapias, Christopher R Morse, Douglas J Mathisen, Henning A Gaissert, Cameron D Wright, James S Allan, Michael Lanuti
BACKGROUND: Epiphrenic esophageal diverticula are infrequent. Although surgical treatment is generally recommended, technique varies widely and optimal management remains controversial. This study evaluated a single-institution experience for surgical treatment of epiphrenic diverticula. METHODS: A retrospective review was made of medical records of 31 patients undergoing surgical treatment for epiphrenic diverticula from 1974 to 2016. RESULTS: There were 17 men (55%); median age was 65 years...
August 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28847538/novel-debate-style-cardiothoracic-surgery-journal-club-results-of-a-pilot-curriculum
#5
Jessica G Y Luc, Tom C Nguyen, Clara S Fowler, Steven B Eisenberg, Randall K Wolf, Anthony L Estrera, Ara A Vaporciyan, Mara B Antonoff
BACKGROUND: Traditional journal clubs addressing single articles are limited by the lack of a standardized process for conduct and evaluation. We developed a novel, debate-style journal club for trainees to use best available evidence to address controversial topics in cardiothoracic surgery through discussion of realistic patient scenarios. METHODS: After implementation of our new curriculum, trainee knowledge acquisition and retention were assessed by a summative test of published literature and standardized debate scoring...
August 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28847537/the-optimal-timing-of-stage-2-palliation-after-the-norwood-operation
#6
James M Meza, Edward Hickey, Brian McCrindle, Eugene Blackstone, Brett Anderson, David Overman, James K Kirklin, Tara Karamlou, Christopher Caldarone, Richard Kim, William DeCampli, Marshall Jacobs, Kristine Guleserian, Jeffrey Jacobs, Robert Jaquiss
BACKGROUND: The effect of the timing of stage-2-palliation (S2P) on survival through single ventricle palliation remains unknown. This study investigated the optimal timing of S2P that minimizes pre-S2P attrition and maximizes post-S2P survival. METHODS: The Congenital Heart Surgeons' Society's critical left ventricular outflow tract obstruction cohort was used. Survival analysis was performed using multiphase parametric hazard analysis. Separate risk factors for death after the Norwood and after S2P were identified...
August 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28847536/long-term-transplant-free-survival-after-repair-of-total-anomalous-pulmonary-venous-connection
#7
James D St Louis, Courtney E McCracken, Elizabeth M Turk, Hayley S Hancock, Jeremiah S Menk, Brian A Harvey, Jeffrey M Vinocur, Matthew E Oster, James H Moller, Logan G Spector, Lazaros K Kochilas
BACKGROUND: Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. METHODS: We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing...
August 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28826991/parents-preferences-regarding-public-reporting-of-outcomes-in-congenital-heart-surgery
#8
Mallory L Irons, J William Gaynor, Thomas L Spray, Chris Feudtner
BACKGROUND: Calls for public reporting of outcomes in congenital heart surgery have led to several different reporting schemes, including a star rating system and benchmark procedure-specific mortality data tables. Important unanswered questions remain about the optimal format and content of public reporting of congenital heart surgery outcomes. METHODS: In conjunction with three parent advocacy groups, we developed a questionnaire to gauge parents' attitudes regarding the format and content of an "optimal" public reporting scheme...
August 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28826990/managing-the-left-atrial-appendage-in-atrial-fibrillation-current-state-of-the-art
#9
REVIEW
Waqaar Khawar, Nathan Smith, Saqib Masroor
BACKGROUND: Patients with atrial fibrillation are at increased risk for thromboembolic stroke originating predominantly in the left atrial appendage. To reduce the risk, the standard of care is anticoagulation. In addition, several devices for exclusion of the left atrial appendage have been developed. METHODS: PubMed was searched for articles relevant to left atrial appendage management. The resulting articles were reviewed as were relevant articles in their bibliographies...
August 19, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28826992/similar-outcomes-in-diabetes-patients-after-coronary-artery-bypass-grafting-with-single-internal-thoracic-artery-plus-radial-artery-grafting-and-bilateral-internal-thoracic-artery-grafting
#10
Sajjad Raza, Eugene H Blackstone, Penny L Houghtaling, Marijan Koprivanac, Kirthi Ravichandren, Hoda Javadikasgari, Faisal G Bakaeen, Lars G Svensson, Joseph F Sabik
BACKGROUND: The purpose of this study was to determine in patients with diabetes mellitus whether single internal thoracic artery (SITA) plus radial artery (RA) grafting yields outcomes similar to those of bilateral internal thoracic artery (BITA) grafting. METHODS: From January 1994 to January 2011, 1,325 diabetic patients underwent primary isolated coronary artery bypass graft surgery with either (1) SITA plus RA with or without saphenous vein (SV) grafts (n = 965) or (2) BITA with or without SV grafts (n = 360); an internal thoracic artery was used in all patients to graft the left anterior descending coronary artery...
August 18, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28822537/impaired-renal-function-should-not-be-a-barrier-to-transplantation-in-patients-with-cystic-fibrosis
#11
Todd C Crawford, J Trent Magruder, Joshua C Grimm, Alejandro Suarez-Pierre, Xun Zhou, Jinny S Ha, Robert S Higgins, Stephen R Broderick, Jonathan B Orens, Pali Shah, Christian A Merlo, Bo S Kim, Errol L Bush
BACKGROUND: Previous studies have demonstrated an association between pretransplantation renal dysfunction (PRD) and increased mortality after lung transplantation (LT). The purpose of this study was to determine whether PRD impacts survival after LT in patients with cystic fibrosis (CF). METHODS: We queried the United Network for Organ Sharing (UNOS) database to identify all adult (≥18 years) recipients with CF who underwent isolated LT from May 4, 2005 to December 31, 2014...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821338/impact-of-delayed-chest-closure-on-surgical-site-infection-after-lung-transplantation
#12
Patrick R Aguilar, Bradford C Bemiss, Chad Witt, Derek E Byers, Daniel Kreisel, Varun Puri, Bryan Meyers, G Alexander Patterson, Alexander S Krupnick, Roger D Yusen, Elbert P Trulock, Ramsey R Hachem
BACKGROUND: Delayed chest closure is an increasingly used approach in the management of bleeding and hemodynamic instability after lung transplantation. We sought to evaluate the impact of delayed chest closure on surgical site infection. METHODS: We performed a single-center retrospective cohort study and included adult patients who received a lung transplant at our center between January 1, 2010, and July 31, 2014. We defined surgical site infection as a thoracotomy incision wound or pleural space infection...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821337/intraoperative-cerebral-perfusion-disturbances-during-transcatheter-aortic-valve-replacement
#13
Jonathon P Fanning, Darren L Walters, Allan J Wesley, Chris Anstey, Samuel Huth, Judith Bellapart, Caroline Collard, Ivan L Rapchuk, Sarvesh Natani, Michael Savage, John F Fraser
BACKGROUND: Transcatheter aortic valve replacement entails profound and unavoidable hemodynamic perturbations that may contribute to the neurological injury associated with the procedure. METHODS: Thirty-one patients were monitored with cerebral oximetry as a surrogate marker of perfusion while undergoing transcatheter aortic valve replacement via a transfemoral approach under general anesthesia to detect intraoperative hypoperfusion insult. Serial neurologic, cognitive, and cerebral magnetic resonance imaging assessments were administered to objectively quantify perioperative neurologic injury and ascertain any association with significant cerebral oximetry disturbances...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821336/a-randomized-clinical-trial-of-red-blood-cell-transfusion-triggers-in-cardiac-surgery
#14
Colleen G Koch, Daniel I Sessler, Edward J Mascha, Joseph F Sabik, Liang Li, Andra I Duncan, Nicole M Zimmerman, Eugene H Blackstone
BACKGROUND: Class I evidence supporting a threshold for transfusion in the cardiac surgical setting is scarce. We randomly allocated patients to a transfusion hematocrit trigger of 24% versus 28% to compare morbidity, mortality, and resource use. METHODS: From March 2007 to August 2014, two centers randomly assigned 722 adults undergoing coronary artery bypass graft surgery or valve procedures to a 24% hematocrit trigger (n = 363, low group) or 28% trigger (n = 354, high group)...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821335/symptoms-are-more-useful-than-echocardiography-in-patient-selection-for%C3%A2-pulmonary-endarterectomy
#15
Laura Donahoe, Rachel Vanderlaan, John Thenganatt, Karen McRae, Anastasia Bykova, Jakov Moric, John Granton, Marc de Perrot
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is still largely underdiagnosed in the general population. Although transthoracic echocardiogram (TTE) is recommended to screen for CTEPH, it may not detect patients with chronic thromboembolic disease (CTED) and mild or exercise-induced pulmonary hypertension (PH) who could also benefit from pulmonary endarterectomy (PEA). METHODS: All patients referred to our CTEPH program with persistent mismatched perfusion defects on ventilation-perfusion (VQ) scan between January 2005 and June 2015 were divided into three groups according to TTE and right heart catheterization (RHC) as follows: (1) typical CTEPH group (PH on RHC and TTE), (2) TTE-negative (neg) CTEPH group (PH on RHC, but not TTE), or (3) CTED group (no PH on RHC and TTE)...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821334/external-validation-of-a-prognostic-model-of-survival-for-resected-typical-bronchial-carcinoids
#16
Maria Cattoni, Eric Vallières, Lisa M Brown, Amir A Sarkeshik, Stefano Margaritora, Alessandra Siciliani, Andrea Imperatori, Nicola Rotolo, Farhood Farjah, Grace Wandell, Kimberly Costas, Catherine Mann, Michal Hubka, Stephen Kaplan, Alexander S Farivar, Ralph W Aye, Brian E Louie
BACKGROUND: This study aimed to assess the reliability and the validity of a prognostic model of survival recently developed by the European Society of Thoracic Surgery Neuroendocrine Tumor Working Group to predict 5-year overall survival after surgical resection of pulmonary typical carcinoid. METHODS: We retrospectively collected data on 240 consecutive patients (164 men, 76 women; median age, 58 years [interquartile range, 47 to 68]) who underwent curative lung resection for pulmonary typical carcinoid in seven centers between 2000 and 2015...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821333/impact-of-pulmonary-flow-study-pressure-on-outcomes-after-one-stage-unifocalization
#17
Matteo Trezzi, Sonia B Albanese, Antonio Albano, Gabriele Rinelli, Carolina D'Anna, Angelo Polito, Enrico Cetrano, Adriano Carotti
BACKGROUND: The purpose of this study was to evaluate the accuracy of the pulmonary flow study in (1) predicting the feasibility of concomitant intracardiac repair after one-stage unifocalization; and in (2) predicting long-term survival and the onset of right ventricular dysfunction after surgery. METHODS: Between October 1996 and July 2015, a flow study was obtained in 95 patients undergoing complete one-stage unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821332/interleukin-8-and-tumor-necrosis-factor-predict-acute-kidney-injury-after-pediatric-cardiac-surgery
#18
Christina A de Fontnouvelle, Jason H Greenberg, Heather R Thiessen-Philbrook, Michael Zappitelli, Jeremy Roth, Kathleen F Kerr, Prasad Devarajan, Michael Shlipak, Steven Coca, Chirag R Parikh
BACKGROUND: Inflammation is a key component of both acute kidney injury (AKI) and response to cardiopulmonary bypass. Because AKI poses risks to children after cardiac surgery, we investigated the value of inflammatory biomarkers interleukin-8 (IL-8) and tumor necrosis factor alpha (TNFα) for predicting AKI and other complications. METHODS: We enrolled 412 children between the ages of 1 month and 18 years undergoing cardiopulmonary bypass for cardiac surgery. We collected blood both preoperatively and postoperatively (within 6 hours post-surgery) and measured plasma IL-8 and TNFα...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821331/nontuberculous-mycobacterium-infections-associated-with-heater-cooler-devices
#19
Keith B Allen, David D Yuh, Suzanne B Schwartz, Richard A Lange, Richard Hopkins, Kelly Bauer, Julia A Marders, Jose Delgado Donayre, Nicole Milligan, Catherine Wentz
BACKGROUND: Disseminated nontuberculous mycobacterium infections have occurred following surgical procedures involving extracorporeal circulation; contaminated water from heater-cooler devices (HCDs) has been implicated as the source. The purpose of this review was to evaluate the public health concern and to educate physicians who care for this patient population. METHODS: The Food and Drug Administration Medical Device Reporting (MDR) database was queried for reports received between January 2010 and August 2016 for patient infections and device contaminations associated with the use of HCDs...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28821330/systemic-atrioventricular-valve-excision-and-ventricular-assist-devices-in-pediatric-patients
#20
Deipanjan Nandi, Kelley D Miller, Carley M Bober, Tami M Rosenthal, Lisa M Montenegro, Joseph W Rossano, J William Gaynor, Christopher E Mascio
BACKGROUND: Continuous-flow ventricular assist devices (CF VADs) designed for adults are increasingly used in pediatric patients. However, there is greater risk of device inflow obstruction as a result of size and anatomy. METHODS: We reviewed all cases of systemic atrioventricular valve (AVV) excision with HeartWare HVAD (HeartWare, Framingham, MA) implantation in the systemic ventricle performed at our institution from November 2015 to May 2016. RESULTS: AVV excision with CF VAD implantation was undertaken in 3 patients...
August 16, 2017: Annals of Thoracic Surgery
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