The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Randomized Controlled TrialA composite outcome for neonatal cardiac surgery research.
The objective of this study was to determine whether a composite outcome, derived of objective signs of inadequate cardiac output, would be associated with other important measures of outcomes and therefore be an appropriate end point for clinical trials in neonatal cardiac surgery. ⋯ The composite outcome is highly associated with important early operative outcomes and may serve as a useful end point for future clinical research in neonates undergoing cardiac operations.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Multicenter StudyNeoadjuvant chemoradiotherapy for locally advanced thymic tumors: a phase II, multi-institutional clinical trial.
To determine the response rate, toxicity, and rate of complete resection after induction chemoradiotherapy for locally advanced thymic tumors, which were defined by specific radiographic criteria. ⋯ The present induction chemoradiotherapy protocol, which used specific computed tomography inclusion criteria to successfully select locally advanced thymic tumors, appeared to be tolerable and resulted in a high rate of complete surgical resection.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyShould surgical ablation for atrial fibrillation be performed in patients with a significantly enlarged left atrium?
One established predictor for failure of surgical ablation for atrial fibrillation is increased left atrial size. Surgeon perception is that surgical ablation in these patients is ineffective and should not be performed. The purpose of this study was to determine whether a larger left atrial size carries a prohibitive risk for failure and embolic events after surgical ablation. ⋯ The large left atrium group had acceptable return to sinus rhythm and sinus rhythm without antiarrhythmic drugs. The embolic stroke rate was low despite the majority of patients not taking anticoagulation. If patients are managed appropriately post-ablation, left atrial size should not be a discouragement when evaluating surgical candidates with atrial fibrillation.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years.
Previous work in our institution has indicated that the Technical Performance Score (TPS) is highly associated with early outcomes in select subsets of procedures and age groups. We hypothesized that the TPS could predict early outcomes in a wide range of diagnoses and age groups. ⋯ The TPS is strongly associated with early outcomes across a wide range of ages and disease complexity and can serve as important tool for self-assessment and quality improvement.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Editorial ReviewCurrent era minimally invasive aortic valve replacement: techniques and practice.
Since the first aortic valve replacement through a right thoracotomy was reported in 1993, upper hemisternotomy and right anterior thoracotomy have become the predominant approaches for minimally invasive aortic valve replacement. Clinical studies have documented equivalent operative mortality, less bleeding, and reduced intensive care/hospital stay compared with conventional sternotomy despite longer procedure times. However, comparative trials face challenges due to patient preference, surgeon bias, and the lack of a standardized minimally invasive surgical approach. ⋯ Surgeons interested in learning and performing minimally invasive aortic valve replacement must have expertise in conventional aortic valve replacement at centers with adequate case volumes. A team approach that coordinates efforts of the surgeon, anesthesiologist, perfusionist, and nurses is required to achieve the best clinical outcomes. By first developing fundamental minimally invasive skills using specialized cannulation techniques, neck lines, and long-shafted instruments in the setting of conventional full sternotomy, the safest operative environment is afforded to patients.