The Annals of thoracic surgery
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Case Reports
Temporary fenestration using venoatrial extracorporeal membrane oxygenation after the Fontan operation.
A 28.7-month-old male child who had undergone a Norwood operation and bidirectional cavopulmonary shunt at the age of 5 days and 6.6 months, respectively, underwent the extracardiac conduit Fontan operation. After the operation, high-volume resuscitation was needed, which led to high central venous pressure (CVP) and low arterial oxygen saturation. ⋯ This low-flow venoatrial ECMO immediately terminated the vicious cycle caused by high venous pressure in the Fontan circulation. He was weaned from ECMO and discharged home.
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Data reported by The Society of Thoracic Surgeons adult cardiac surgery database demonstrate that only 38% of patients with atrial fibrillation (AF) underwent a concomitant surgical ablation. Surgeons are reluctant to add complexity and potential morbidity by including an additional procedure when performing surgery in higher operative risk patients. We investigated perioperative and long-term outcomes in high-risk patients who underwent open heart surgery with or without surgical ablation for AF. ⋯ The addition of an AF surgical ablation procedure did not add operative risk to patients considered high risk, and potentially improved long-term outcome for the subgroup of patients who had their AF ablated. This study suggests that the degree of surgical risk should not be the only decision factor when evaluating this challenging group of patients for surgical ablation.
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Pleurobiliary fistula after blunt abdominal trauma is rare. We report a case managed with tube thoracostomy alone, without the need for biliary system drainage.
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Previous studies suggest center volume is associated with outcome after the Norwood operation; however, the impact of surgeon volume is less clear. We evaluated the relative impact of surgeon and center volume on mortality in a large Norwood cohort. ⋯ Both center and surgeon volumes appear to influence Norwood outcomes. These data suggest outcomes may potentially be improved through strategies that take advantage of the positive influence of both of these variables. This could include further investigation into the feasibility of regional collaborations, and the development of quality improvement initiatives within and across centers.
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During the past decade, use has increased of moderate hypothermic circulatory arrest with antegrade cerebral perfusion for cerebral protection during aortic arch operations. This study examined the use of mild hypothermia in conjunction with unilateral selective antegrade cerebral perfusion (uSACP) for hemiarch replacement for proximal aortic arch reconstruction. ⋯ Hemiarch replacement can be safely performed at 28°C with uSACP in emergency and elective settings. Mild hypothermia with uSACP offers adequate levels of neurologic protection compared with deeper levels of hypothermia.