The Annals of thoracic surgery
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Adoption of simulation skills training in cardiothoracic (CT) surgery remains a challenge. This study sought to determine whether a "Top Gun" competition would encourage simulator use and improve technical skills among first-year CT residents. ⋯ Focused training results in improved technical skills in vessel anastomosis, especially for residents with lower baseline skills. Simulation, as with any educational endeavor, requires the motivation of the trainee, commitment of the faculty educator, and a defined training curriculum.
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Comparative Study
Incidence and mechanisms of cerebral ischemia after transcatheter aortic valve implantation compared with surgical aortic valve replacement.
The most likely mechanisms of neurologic injury after transcatheter aortic valve implantation (TAVI) and aortic valve replacement (AVR) are cerebral embolization and hypoperfusion. We set out to determine potential mechanisms of neurologic injury after TAVI compared with AVR. ⋯ At 3 months follow-up, overall cognitive score was higher in AVR compared with TAVI, adjusted for baseline score. However, there was no difference in cerebral embolic load, ischemic lesions, and oxygen desaturation.
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The use of venous-venous extracorporeal life support (VV ECLS) for the endoscopic management of airway obstruction has been rarely reported. In most instances, ECLS has been used in the setting of cardiopulmonary resuscitation in which venoarterial ECLS was initiated as part of resuscitation. We report a patient with a bulky primary tumor of the tracheal carina presenting with airway obstruction who was managed with intraoperative single-cannula VV ECLS to facilitate endoscopic interventions leading to more definitive airway security.
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To assess the utility of neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury (AKI) occurring after cardiac surgery in patients with prior chronic kidney failure. ⋯ Earlier diagnosis of AKI post-surgery based on NGAL assessment makes it possible to initiate appropriate therapy at an earlier stage in this high-risk patient population.
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Observational Study
Acute degradation of the endothelial glycocalyx in infants undergoing cardiac surgical procedures.
There is no doubt today about the existence of the endothelial glycocalyx (EG) and its decisive role in maintaining vascular homeostasis in adult humans. Shedding of the EG has been demonstrated in adults with sepsis or trauma, in patients undergoing major operations, and after ischemia/reperfusion. The aim of the present study was to demonstrate whether shedding of the EG also occurs in infants undergoing heart operations. ⋯ The present data provides the first evidence for basal turnover of vascular EG in infants. Similarly to the process in adults, the shedding of this structure increases with ischemia/reperfusion, the extent being dependent on the degree of ischemic challenge.