The Annals of thoracic surgery
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Review Multicenter Study Comparative Study
Blood transfusion and infection after cardiac surgery.
Cardiac surgery is the largest consumer of blood products in medicine; although believed life saving, transfusion carries substantial adverse risks. This study characterizes the relationship between transfusion and risk of major infection after cardiac surgery. In all, 5,158 adults were prospectively enrolled to assess infections after cardiac surgery. ⋯ Risk factors for infection included postoperative RBC units transfused, longer duration of surgery, and transplant or ventricular assist device implantation, in addition to chronic obstructive pulmonary disease, heart failure, and elevated preoperative creatinine. Platelet transfusion decreased the risk of infection (p = 0.02). Greater attention to management practices that limit RBC use, including cell salvage, small priming volumes, vacuum-assisted venous return with rapid autologous priming, and ultrafiltration, and preoperative and intraoperative measures to elevate hematocrit could potentially reduce occurrence of major postoperative infections.
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A 51-year-old man with severe mitral regurgitation was admitted. While undergoing preoperative examination for mitral disease, he was found to have absence of the right superior vena cava and a persistent left superior vena cava. ⋯ There were no difficulties during the operation. Isolated persistent left superior vena cava is very rare, but if it is diagnosed preoperatively and an appropriate operative plan is made, MICS can be performed safely.
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Comparative Study
Arterial switch for transposition with left outflow tract obstruction: outcomes and risk analysis.
The long-term results and indications of the arterial switch operation (ASO) for transposition of the great arteries (TGA) and anatomic left ventricular outflow tract obstruction (LVOTO) remain undetermined. The aims of this study were to determine long-term outcomes and prognostic factors in this specific population. ⋯ Long-term outcomes of ASO for patients with TGA and anatomic LVOTO are satisfactory in selected patients. A lower preoperative pulmonary valve z-score and complex multilevel atrioventricular valve-related LVOTO are independent predictors of recurrent LVOTO and LVOT reoperation. TGA/LVOTO patients with pulmonary valve z-score exceeding -1.8 and resectable valvular or subvalvular LVOTO, or both, should be candidates for ASO, regardless of the severity of the LVOT peak gradient.
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Randomized Controlled Trial Comparative Study
Sustained supervised practice on a coronary anastomosis simulator increases medical student interest in surgery, unsupervised practice does not.
Given declining interest in cardiothoracic (CT) training programs during the last decade, increasing emphasis has been placed on engaging candidates early in their training. We examined the effect of supervised and unsupervised practice on medical students' interest in CT surgery. ⋯ Supervised training on low-fidelity simulators enhances interest in a career in surgery. Practice that lacks supervision does not, possibly related to the complexity of the simulated task. Mentorship efforts may need to involve sustained interaction to provide medical students with enough exposure to appreciate a surgical career.
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Comparative Study
Comparison of three measurements on computed tomography for the prediction of less invasiveness in patients with clinical stage I non-small cell lung cancer.
A greater proportion of ground-glass opacity (GGO) is well known to be strongly associated with less invasive lung adenocarcinoma. Recently, the solid area diameter has also been reported to be a simple and better marker for the same purpose compared with the whole nodule diameter. ⋯ Proportion of GGO remains important for predicting less invasive lung cancer.