The Annals of thoracic surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
On-pump versus off-pump coronary artery bypass surgery: cost-effectiveness analysis alongside a multisite trial.
Questions have been raised about the costs and outcomes for patients receiving on-pump and off-pump coronary artery bypass graft surgery. As part of the Department of Veterans Affairs Randomized On/Off Bypass (ROOBY) multisite trial, a cost-effectiveness analysis was performed to compare on-pump versus off-pump patients' quality-adjusted life-years and costs at 1 year. ⋯ At 1 year, off-pump coronary artery bypass graft surgery was more expensive than on-pump when late off-pump-to-on-pump conversions were included. Excluding late conversions, there was no difference in quality-adjusted life-years or costs.
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Comparative Study
Revascularization for the right coronary artery territory in off-pump coronary artery bypass surgery.
Graft selection for the right coronary artery territory remains controversial. The objective of this study was to analyze outcomes from revascularization of the right coronary artery territory using the right internal thoracic artery (RITA), the right gastroepiploic artery (RGEA), or a saphenous vein graft (SVG). ⋯ Arterial grafts should be considered the first choice for right coronary artery territory revascularization in off-pump coronary artery bypass. However, SVG should be considered when proximal stenosis is less than 90%.
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Comparative Study
Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient.
Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. ⋯ Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.
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Comparative Study
Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era.
In the era of destination continuous flow left ventricular assist devices (LVAD), the decision of whether a patient will tolerate isolated LVAD support or will need biventricular support (BIVAD) can be challenging. Incorrect decision making with delayed right ventricular (RV) assist device implantation results in increased morbidity and mortality. Continuous flow LVADs have been shown to decrease pulmonary hypertension and improve RV function. We undertook this study to determine predictors in the continuous flow LVAD era that identify patients who are candidates for isolated LVAD therapy as opposed to biventricular support. ⋯ We present a preoperative risk calculator to determine suitability of a patient for isolated LVAD support in the current continuous flow ventricular assist device era.