The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions.
The cardiac workload associated with various types of aortic obstruction was determined using computational fluid dynamic simulations. ⋯ The present study has determined the hemodynamic significance of aortic arch obstruction using computational simulations to calculate the cardiac workload. These results suggest that all types of hypoplasia pose more of a workload challenge than coarctation with an equivalent degree of narrowing.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Nationwide outcomes of surgical embolectomy for acute pulmonary embolism.
The aim of the present study was to review nationwide outcomes of surgical embolectomy for acute pulmonary embolism. ⋯ This large-cohort analysis of more than 2700 patients demonstrates a nationwide inpatient mortality rate of 27.2% after pulmonary embolectomy. Although patient factors affect mortality, the arena of care appears to have no significant effect on operative outcomes. This suggests that it might be more prudent for centers with qualified surgeons to avoid delays in treatment, rather than transfer care because of a perception of improved outcomes.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyOrthotopic heart transplant versus left ventricular assist device: a national comparison of cost and survival.
Orthotopic heart transplantation is the standard of care for end-stage heart disease. Left ventricular assist device implantation offers an alternative treatment approach. Left ventricular assist device practice has changed dramatically since the 2008 Food and Drug Administration approval of the HeartMate II (Thoratec, Pleasanton, Calif), but at what societal cost? The present study examined the cost and efficacy of both treatments over time. ⋯ Since Food and Drug Administration approval of the HeartMate II, mortality after left ventricular assist device implantation has decreased rapidly, yet has remained greater than that after orthotopic heart transplantation. The left ventricular assist device costs have continued to increase and have been significantly greater than those for orthotopic heart transplantation. Because of the evolving healthcare economics climate, with increasing emphasis on the costs and comparative effectiveness, a concerted effort at LVAD cost containment and judicious usage is essential to preserve the viability of this invaluable treatment.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Evolving trends of reoperative coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
The present study evaluated the evolving trends and outcomes of patients undergoing isolated reoperative coronary artery bypass grafting at Society of Thoracic Surgeons Adult Cardiac Surgery Database-participating institutions. ⋯ Surgical coronary revascularization has evolved during the past decade, with reoperative coronary artery bypass grafting now uncommonly performed in contemporary practice. Despite treating patients with more complex coronary artery disease and greater medical comorbidities, significant improvements have occurred in operative morbidity and mortality in this challenging population.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyIncreased extracorporeal membrane oxygenation center case volume is associated with improved extracorporeal membrane oxygenation survival among pediatric patients.
We sought to examine the relationship between extracorporeal membrane oxygenation center case volume and survival in pediatric patients requiring extracorporeal membrane oxygenation support. ⋯ Higher extracorporeal membrane oxygenation case volume is associated with improved hospital survival in pediatric cardiac extracorporeal membrane oxygenation patients. The results of this study may support the paradigm of regionalized centers of excellence for managing pediatric cardiac extracorporeal membrane oxygenation patients.