The Annals of thoracic surgery
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Review Comparative Study
Associated factors and trends in outcomes of interrupted aortic arch.
Interrupted aortic arch (IAA) continues to be associated with important mortality, both before and immediately after repair, with ongoing morbidity during follow-up. We sought to determine trends in presentation, management, outcomes and associated factors. ⋯ While improving, outcomes of IAA remain of concern, especially in patients with associated lesions.
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Severe, refractory hypoxemia complicating uncorrected cyanotic congenital heart disease is a potentially lethal condition, even when urgent surgical intervention is undertaken. When a viral pneumonia initiates hypoxemia, the likelihood of a satisfactory outcome is further reduced. We examined our policy of venovenous extracorporeal membrane oxygenation support through the hypoxic event and performing delayed surgery, if required, to separate from extracorporeal membrane oxygenation. ⋯ Venovenous extracorporeal membrane oxygenation allows time for the recovery of acute hypoxic insult and resolution of some viral pneumonia processes. Palliative surgical procedures may be safely undertaken during extracorporeal support. Viral pneumonia is a risk for prolonged support. Venovenous extracorporeal membrane oxygenation is useful in these high-risk patients.
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Applications to cardiothoracic surgery training programs have declined. Anecdotal evidence suggests limited job availability for residents completing cardiothoracic training, which may contribute to this decline. This survey sought to document the experience of current, graduating residents. ⋯ Most cardiothoracic residents were successful in finding employment after training. A substantial percentage, however, pursued additional training due to lack of job opportunities. Although most finishing residents were satisfied with training and career choice, significant concerns exist regarding job opportunities and compensation. These conditions may lead to difficulty in recruitment to the specialty.
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Review Comparative Study
Sternal preservation: a better way to treat most sternal wound complications after cardiac surgery.
Postcardiotomy sternal wound complications remain challenging. The prevailing approach for deep sternal wound infection of debridement and flap coverage without osseous closure makes subsequent reoperation difficult. ⋯ In patients with postcardiotomy deep sternal wound infection without previous chest radiation, debridement, rewiring, and delayed skin closure is effective. It offers a shorter healing time and probably makes late cardiac reoperation safer. We propose an algorithm for the management of poststernotomy complications.
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Multicenter Study Comparative Study Clinical Trial
A prospective multicenter trial of bipolar radiofrequency ablation for atrial fibrillation: early results.
The Cox-Maze III remains the gold standard for the surgical treatment of atrial fibrillation. However, the "cut-and-sew" technique is time consuming and technically challenging. The pulmonary veins are the source of ectopy in the majority of patients with atrial fibrillation. The safety and efficacy of bipolar radiofrequency to electrically isolate the pulmonary veins was evaluated in a prospective multi-center trial. ⋯ The use of bipolar radiofrequency for electrical isolation of pulmonary veins and to replace other Cox-Maze III incisions is safe and effective at controlling atrial fibrillation. This emerging technology may shorten and simplify the surgical management of atrial fibrillation.