The Annals of thoracic surgery
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Midventricular obstruction in hypertrophic cardiomyopathy (HCM) is less common than subaortic obstruction, and there are few data on outcomes after surgical treatment. ⋯ A transapical approach allows excellent exposure for midventricular myectomy and relief of intraventricular gradients and related symptoms. There were no complications unique to the apical incision, and 5-year survival was similar to expected survival (95% versus 97%).
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Multicenter Study Comparative Study
Hospital variation in postoperative infection and outcome after congenital heart surgery.
Several initiatives aim to reduce postoperative infection across a variety of surgical patients as a means to improve overall quality of care and reduce variation across centers. However, the association of infection rates with hospital-level outcomes and resource utilization has not been well described. We evaluated this association across a multicenter cohort undergoing congenital heart surgery. ⋯ Infection after congenital heart surgery contributes to prolonged LOS and increased costs on a hospital level. However, given that infection rates alone explained relatively little of the variation in these outcomes across hospitals, further study is needed to identify additional factors that may be targeted in initiatives to reduce variation and improve outcomes across centers.
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Ischemia-reperfusion injury occurs during coronary artery bypass graft operations. Strategies are needed to lower the extent of damage. ⋯ This review provides a look at potential mechanisms involved in remote ischemic preconditioning, experimental evidence supporting it, clinical studies that support and negate it, and potential reasons for differences between clinical studies. With remote ischemic preconditioning having the potential to better clinical outcomes in patients undergoing coronary artery bypass graft operations, a large clinical trial needs to be undertaken to better assess its practical clinical application.
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Chronic kidney disease is a significant risk factor for mortality as well as acute kidney injury in cardiac surgery. The impact of contrast agent application on outcome is not well described in patients undergoing transcatheter aortic valve implantation. ⋯ Preoperative chronic kidney disease does not increase the risk of mortality and acute kidney injury after transcatheter aortic valve implantation. Acute kidney injury after TAVI is associated with an elevated risk of mortality. The amount of contrast agent applied intra-procedurally does not affect the risk of acute kidney injury.