The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Gamification in thoracic surgical education: Using competition to fuel performance.
In an effort to stimulate residents and trainers to increase their use of simulation training and the Thoracic Surgery Curriculum, a gamification strategy was developed in a friendly but competitive environment. ⋯ This gamification approach focused on technical and cognitive skills, has been successfully implemented, and has encouraged the use of simulators and the Thoracic Surgery Curriculum. This framework may capitalize on the competitive nature of our trainees and can provide recognition of their achievements.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Multicenter StudyEuropean multicenter experience with valve-sparing reoperations after the Ross procedure.
Autograft valve preservation at reoperation may conserve some of the advantages of the Ross procedure. However, results of long-term follow-up are lacking. In this retrospective multicenter study, we present our experience with valve-sparing reoperations after the Ross procedure, with a focus on long-term outcome. ⋯ Valve-sparing autograft reoperations after the Ross procedure carry a low operative risk, with acceptable reintervention rates in the first postoperative decade. Patients with isolated and/or severe autograft regurgitation have an increased hazard of reintervention after valve-sparing reoperation; for these patients, careful preoperative weighing of surgical options is required.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Comparative StudyEarly surgical intervention versus watchful waiting and outcomes for asymptomatic severe aortic regurgitation.
The management of asymptomatic patients with severe aortic regurgitation remains controversial. Accordingly, the aim of the present study was to assess the long-term outcomes and incidence of cardiac complications among asymptomatic patients with severe aortic regurgitation who underwent operation early, in the absence of any class I or class IIa guideline triggers, or were managed conservatively and eventually underwent operation whenever these triggers appeared. ⋯ Our results show that the outcome of asymptomatic patients with severe aortic regurgitation is not different between an early surgical and a more conservative strategy, provided that the conservatively managed patients are regularly followed up and timely referred to surgery as soon as operative triggers develop. This suggests that surgery should not be recommended in patients with aortic regurgitation who do not meet current guidelines for intervention.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Should asymptomatic patients discharged with lower hemoglobin expect worse outcomes after valve surgery?
Blood transfusion in cardiac surgery patients is associated with increased morbidity and cost. The decision to transfuse patients after surgery varies but is often based on low hemoglobin (Hgb) levels, regardless of symptom status. This study examined whether asymptomatic patients discharged with lower Hgb levels had increased risk for perioperative complications and 1-year mortality. ⋯ Asymptomatic patients discharged with lower Hgb levels did not manifest inferior outcomes, including perioperative morbidity/mortality, readmission <30 days, HRQL, and 1-year survival. The practice of blood transfusion to correct lower Hgb levels in asymptomatic patients should be eliminated, as it may be associated with increased morbidity without apparent clinical benefits after valve surgery.
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J. Thorac. Cardiovasc. Surg. · Nov 2015
Comparative StudyComparison of perfusion and thickening between vein and right internal thoracic artery composite grafts from a randomized trial substudy.
Improvements in myocardial perfusion and thickening were compared in coronary artery bypass grafting patients who received saphenous vein (SV) Y-composite grafts versus those who received right internal thoracic artery ([R]ITA) Y-composite grafts. ⋯ Improvements in myocardial perfusion and segmental myocardial thickening were similar between the 2 groups at 1 year after revascularization. The SV, versus the right ITA, composite graft may be more beneficial in perfusion improvement of the right coronary artery territory.