The Annals of thoracic surgery
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Uncommonly, adults with functionally univentricular hearts are becoming candidates for a Fontan procedure. The purpose of this study was to evaluate the course of patients undergoing the modified Fontan procedure with an extracardiac conduit in recent years. ⋯ The modified Fontan procedure with use of an extracardiac conduit can be performed in adults with encouraging early and midterm results. The majority of late survivors had improved quality of life. The incidence of late death, reoperation, arrhythmias, and thromboembolic events was low during follow-up.
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Multicenter Study
Predictors of mortality after surgical management of lung cancer in the National Cancer Database.
Surgical resection represents the standard of care for locoregionally confined non-small cell lung cancer (NSCLC); however, surgical complications may compromise the overall outcome. Adverse events after lung cancer surgery have been studied extensively, yet available databases have significant limitations (with respect to size, provider, patient age, and so forth). The National Cancer Database (NCDB) is the largest cancer registry in the world, capturing 67% of newly diagnosed NSCLC in the United States. We studied surgically managed NSCLC patients in the NCDB to more accurately assess factors that influence perioperative outcomes. ⋯ Adverse events after the surgical treatment of NSCLC in the NCDB occur with a similar frequency and are predicted by similar patient, procedural, and facility variables as have been identified by more restricted data resources. The NCDB appears to be a valuable resource to study NSCLC in the United States.
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Multicenter Study
The association of transcatheter aortic valve replacement availability and hospital aortic valve replacement volume and mortality in the United States.
Whether the introduction of transcatheter aortic valve replacement (TAVR) has affected hospitals' surgical aortic valve replacement (SAVR) and overall aortic valve replacement (AVR) case volumes and outcomes in the United States is unknown. ⋯ Since the introduction of TAVR, the total volume of AVR procedures, including higher overall use of SAVR, at TAVR sites has significantly increased in the United States. Overall, in-hospital survival of patients undergoing treatment for aortic valve stenosis continues to improve.
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Multicenter Study
Survival benefit of lung transplantation for chronic obstructive pulmonary disease in Sweden.
Lung transplantation (LTx) is a therapeutic option for patients with life-threatening chronic obstructive pulmonary disease (COPD) that is refractory to conventional therapies. The survival benefit of LTx for COPD is difficult to assess. The aim of this study was to evaluate the Swedish series of LTx performed to treat COPD and to identify differences in outcome between COPD related to severe alpha-1-antitrypsin deficiency (AATD) and COPD with normal alpha-1-antitrypsin (AAT) levels. ⋯ Survival after LTx is significantly better for patients with severe AATD and end stage COPD than for the patients with COPD related to cigarette smoking.
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Multicenter Study
Association of center volume with outcomes: analysis of verified data of European Association for Cardio-Thoracic Surgery Congenital Database.
The relation between surgical volumes and outcome in congenital heart surgery (CHS) was investigated with no clear conclusions. We sought to quantify the relationship between surgical volume and surgical performance defined as the relation between outcome and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Score and The Society of Thoracic Surgeons (STS) Morbidity Score. ⋯ Our analysis suggests that after adjustment for case mix higher programmatic volume is associated with lower rates of mortality and morbidity. The small- and medium-volume centers have higher rates of major complications. When complications occurred the chance of rescue is higher in large-volume centers.