Circulation
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Geospatial methods using mathematical optimization to identify clusters of cardiac arrests and prioritize public locations for defibrillator deployment have not been studied. Our objective was to develop such a method and test its performance against a population-guided approach. ⋯ Geographic clusters of cardiac arrests can be easily identified and prioritized with the use of mathematical modeling. Optimized AED deployment can increase cardiac arrest coverage and decrease the distance to the closest AED. Mathematical modeling can augment public AED deployment programs.
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Review Case Reports
Treatment of acute and recurrent idiopathic pericarditis.
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Multicenter Study Clinical Trial
Berlin Heart EXCOR pediatric ventricular assist device for bridge to heart transplantation in US children.
Recent data suggest that the Berlin Heart EXCOR Pediatric ventricular assist device is superior to extracorporeal membrane oxygenation for bridge to heart transplantation. Published data are limited to 1 in 4 children who received the device as part of the US clinical trial. We analyzed outcomes for all US children who received the EXCOR to characterize device outcomes in an unselected cohort and to identify risk factors for mortality to facilitate patient selection. ⋯ Use of the Berlin Heart EXCOR has risen dramatically over the past decade. The EXCOR has emerged as a new treatment standard in the United States for pediatric bridge to transplantation. Three-quarters of children survived to transplantation or recovery; an important fraction experienced neurological dysfunction. Smaller patient size, renal dysfunction, hepatic dysfunction, and biventricular assist device use were associated with mortality, whereas extracorporeal membrane oxygenation before implantation and congenital heart disease were not.
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There is a paucity of long-term data comparing biological versus mechanical aortic valve prostheses in older individuals. ⋯ Among patients undergoing aortic valve replacement, long-term mortality rates were similar for those who received bioprosthetic versus mechanical valves. Bioprostheses were associated with a higher long-term risk of reoperation and endocarditis but a lower risk of stroke and hemorrhage. These risks varied as a function of a patient's age and comorbidities.