The Annals of thoracic surgery
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Comparative Study
Analyzing "failure to rescue": is this an opportunity for outcome improvement in cardiac surgery?
In the setting of a statewide quality collaborative approach to the review of cardiac surgical mortalities in intensive care units (ICUs), variations in complication-related outcomes became apparent. Utilizing "failure to rescue" methodology (FTR; the probability of death after a complication), we compared FTR rates after adult cardiac surgery in low, medium, and high mortality centers from a voluntary, 33-center quality collaborative. ⋯ Low mortality hospitals have superior ability to rescue patients from complications after cardiac surgery procedures. Outcomes review incorporating a collaborative multi-hospital approach can provide an ideal opportunity to review processes that anticipate and manage complications in the ICU and help recognize and share "differentiators" in care.
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Interventricular septal hematoma is a very rare complication after congenital heart surgery. We report our experience with 2 cases; 1 unsuccessful attempt in a child with a ventricular septal defect and 1 successful palliation in a child with tetralogy of Fallot. On comparison with previously reported results, children seem to have better outcomes than adults. While the first choice for a hemodynamically unstable patient is surgical revision, individualized therapy should also be considered.
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Randomized Controlled Trial Comparative Study
Methylprednisolone in neonatal cardiac surgery: reduced inflammation without improved clinical outcome.
Corticosteroids are widely used in pediatric open-heart surgery to reduce systemic inflammatory response and to mediate possible cardioprotective effects. However, the optimal dosing of corticosteroids is unknown and their administration varies considerably between different institutions. ⋯ Intravenous 30 mg/kg methylprednisolone administered before cardiopulmonary bypass resulted in high effective plasma drug concentrations and a decreased inflammatory response. However, no cardioprotective effect or better clinical outcome was noticed.
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Comparative Study
Variation in warfarin thromboprophylaxis after mitral valve repair: does equipoise exist and is a randomized trial warranted?
There are limited data available to inform decision making regarding warfarin thromboprophylaxis early after mitral valve repair. ⋯ At present, half of patients are prescribed warfarin after isolated mitral valve repair in North American cardiac surgical practice which may impact the length of hospital stay. Although patient-level predictors of warfarin prescription exist, center- and surgeon-level variations are prominent. There is a pressing need for a randomized trial both to guide therapy and to ascertain the potential for resource conservation.
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Comparative Study
Tricuspid reoperation after left-sided rheumatic valve operations.
The management of late tricuspid regurgitation after left-sided valve operations in rheumatic patients remains controversial. The aim of this study was to analyze clinical and echocardiographic outcomes of tricuspid valve procedures after left-sided valve operations in rheumatic patients. ⋯ Tricuspid valve procedures after left-sided valve operations in rheumatic patients can be performed at low risk with good clinical outcomes. For improved clinical outcomes, early surgical intervention should be considered before the development of anemia and left ventricular dysfunction. A lower aortic transprosthetic mean pressure gradient may help prevent late progression of tricuspid regurgitation in a clinical setting.