The Annals of thoracic surgery
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As overall mortality rates have fallen in pediatric cardiac surgical procedures, complication monitoring is becoming an increasingly important metric of patient outcome. Currently there is no standardized method available to monitor severity-adjusted complications in congenital cardiac surgical procedures. ⋯ The O:E plot provides a simple and effective system to monitor complication rates over time based on severity-adjusted complication data. Grouping complications into classes allows us to identify specific subsets of complications that can be focused on to improve patient outcomes.
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Comparative Study
Comparison of late coronary artery bypass graft survival effects of radial artery versus saphenous vein grafting in male and female patients.
This study aimed to compare the survival benefit derived from using radial artery (RA) as a second arterial conduit in combination with internal thoracic artery (ITA), as opposed to ITA plus saphenous vein (SV) in men and women. ⋯ Late survival results suggest that male and female CABG patients benefit appreciably from use of RA as a second arterial conduit in combination with ITA. Yet, the late survival advantage derived from RA use was relatively less for women. This sex variance in benefit likely reflects differences in risk profiles of male and female CABG patients.
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Comparative Study
Late effects of radial artery versus saphenous vein grafting in patients aged 70 years or older.
We aimed to determine whether the reported late survival benefit of radial artery (RA) versus saphenous vein (SV) grafting in the general coronary artery bypass graft surgery (CABG) population is maintained in elderly patients aged 70 years or older. ⋯ The late survival results suggest that elderly (≥70 years) primary multivessel CABG patients benefit substantially when RA is used as the second conduit in combination with ITA. Indeed, compared with previously published comparisons including all age groups, the derived risk ratio indicates that the benefit for the elderly may exceed that for younger patients in the initial decade after CABG. Use of RA should not be avoided in the elderly.
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Surgical treatment is an option for both type A aortic dissection and complicated type B aortic dissection. Acute kidney injury (AKI) influences the disease course after surgery. Our hypothesis was that AKI should be an important prognostic factor for aortic dissection after surgical treatment. ⋯ Our study provides outcomes of postoperative aortic dissection. We found that AKI was a predictor of 1-year mortality by using the RIFLE criteria. Factors associated with increased 1-year mortality and AKI should be taken into consideration for surgery and postoperative care.
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Arch reconstruction is a key part of the Norwood operation for hypoplastic left heart syndrome and is related to late morbidity. Since 2003, our surgical technique has been standardized to a right ventricle to pulmonary artery conduit, arch reconstruction with homograft patch, and Damus-Kaye-Stansel anastomosis onto homograft patch, with partial or complete resection of any coarctation ridge. We studied the impact of the surgical approach on arch reinterventions and outcome. ⋯ Our standard technique for the Norwood operation has good results but further intervention for recoarctation is common. Size of ascending aorta and incomplete resection of coarctation tissue were risk factors for recoarctation. Complete resection of coarctation tissue may reduce the incidence of recoarctation. A small ascending aorta may predict late arch problems.