The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Comparative StudyDefining operative mortality: Impact on outcome reporting.
Death is an important outcome of procedural interventions. The death rate, or mortality rate, is subject to variability by definition. The Society of Thoracic Surgeons Adult Cardiac Surgery Database definition of "operative" mortality originally included all in-hospital deaths and deaths occurring within 30 days of the procedure. In recent versions of the Society of Thoracic Surgeons Adult Cardiac Surgery Database, "in-hospital" has been modified to include "patients transferred to other acute care facilities," and "deaths within 30 days unless clearly unrelated to the procedure" has been changed to "deaths within 30 days regardless of cause." This study addresses the impact of these redefinitions on outcome reporting. ⋯ A significant percentage of procedural deaths occur after transfer or discharge from the index hospital. This is especially evident in the percutaneous coronary intervention group. These findings illustrate the importance of the definition of "operative" mortality and the need to ensure accuracy in the reporting of data to voluntary clinical registries, such as the Society of Thoracic Surgeons Adult Cardiac Surgery Database and National Cardiovascular Data Registry.
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Observational StudyNeurodevelopmental outcomes after neonatal cardiac surgery: Role of cortical isoelectric activity.
Neonates with congenital heart disease are at risk for impaired neurodevelopment after cardiac surgery. We hypothesized that intraoperative EEG activity may provide insight into future neurodevelopmental outcomes. ⋯ The duration of cortical isoelectric states seems related to neurodevelopmental outcomes. Strategies using continuous EEG monitoring to minimize isoelectric states may be useful during complex congenital heart surgery.
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?
This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome. ⋯ In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with hypoplastic left heart syndrome and variants. Further refinements are warranted to decrease patient morbidity.
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Practice GuidelineSurgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
Two guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: The "2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease" (J Am Coll Cardiol. 2010;55:e27-130) and the "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease" (J Am Coll Cardiol. 2014;63:e57-185). However, the 2 guidelines differ with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves. The ACC and AHA therefore convened a subcommittee representing members of the 2 guideline writing committees to review the evidence, reach consensus, and draft a statement of clarification for both guidelines. This statement of clarification uses the ACC/AHA revised structure for delineating the Class of Recommendation and Level of Evidence to provide recommendations that replace those contained in Section 9.2.2.1 of the thoracic aortic disease guideline and Section 5.1.3 of the valvular heart disease guideline.