The Annals of thoracic surgery
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Observational Study
Aortic valve replacement through right anterior minithoracotomy: can sutureless technology improve clinical outcomes?
The impact of sutureless prosthesis on the clinical outcome in minimally invasive aortic valve replacement is still unclear. We assessed mid-term outcomes of the sutureless and conventional valves implanted through right anterior minithoracotomy. ⋯ In the present limited cohort of patients, sutureless prostheses reduced operative times for aortic valve replacement and the duration of mechanically assisted ventilation and might have influenced early and mid-term survival. Larger studies are needed to confirm our data and compare long-term outcomes.
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Multicenter Study
Excess costs associated with complications and prolonged length of stay after congenital heart surgery.
While there is an increasing emphasis on both optimizing quality of care and reducing health care costs, there are limited data regarding how to best achieve these goals for common and resource-intense conditions such as congenital heart disease. We evaluated excess costs associated with complications and prolonged length of stay (LOS) after congenital heart surgery in a large multicenter cohort. ⋯ Complications and prolonged LOS after congenital heart surgery are associated with significant costs. Initiatives able to achieve even modest reductions in these morbidities may lead to both improved outcomes and cost savings across both moderate and high complexity operations.
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Multicenter Study
Quantifying the safety benefits of wedge resection: a society of thoracic surgery database propensity-matched analysis.
Wedge resection is often used instead of anatomic resection in an attempt to mitigate perioperative risk. In propensity-matched populations, we sought to compare the perioperative outcomes of patients undergoing wedge resection with those undergoing anatomic resection. ⋯ Wedge resection has a 37% lower mortality and 50% lower major morbidity rate than anatomic resection in these propensity-matched populations. The mortality benefit is most apparent in patients with forced expiratory volume in 1 second less than 85% predicted. These perioperative benefits must be carefully weighed against the increase in locoregional recurrence and possible decrease in long-term survival associated with the use of wedge resection for primary lung cancers.
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Readmission after operations for congenital heart conditions has significant implications for patient care. Readmission rates vary between 8.7% and 15%. The aim of this study was to determine the incidence, causes, and risk factors associated with readmission. ⋯ The incidence of readmission after operations for congenital cardiac conditions remains high. Efforts focusing on patients with single-ventricle palliation and those with preoperative arrhythmia, prolonged postoperative length of stay and nasogastric tube feeding at discharge may be particularly beneficial.
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Minimally invasive, right thoracotomy (port access) approaches to intracardiac operations (mitral valve, tricuspid valve, atrial septal defect, intracardiac tumors) are becoming increasingly accepted by surgeons, cardiologists, and patients alike. Standard techniques for cardioplegic arrest of the heart have included endoaortic balloons and Chitwood clamps. Concerns have been raised regarding the potential increased risk of vascular adverse events (embolization, dissection, stroke, lower extremity ischemia) associated with endoaortic balloon occlusion. We undertook this study to evaluate the vascular risk associated with endoaortic balloon use. ⋯ Minimally invasive cardiac operations using a peripheral cannulation strategy can be safely performed with minimal vascular adverse events incorporating either endoaortic balloon or Chitwood clamp aortic occlusion. As experience with the endoaortic balloon is gained, the incidence of vascular adverse events can be reduced to nearly negligible rates.