The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jul 2017
Reengineering valve patients' postdischarge management for adapting to bundled payment models.
Bundled Payments for Care Improvement (BPCI) initiatives were developed by Medicare in an effort to reduce expenditures while preserving quality of care. Payment model 2 reimburses based on a target price for 90-day episode of care postprocedure. The challenge for valve patients is the historically high (>35%) 90-day readmission rate. We analyzed our institutional cardiac surgical service line adaptation to this initiative. ⋯ Our reengineering of pre/postdischarge management of BPCI valve patients under tight CNP control has significantly reduced costly 30-day readmissions in this high-risk population.
-
J. Thorac. Cardiovasc. Surg. · Jul 2017
Transapical transcatheter aortic valve implantation using the J-Valve system: A 1-year follow-up study.
Transcatheter aortic valve implantation has become a routine procedure to treat screened inoperable or high-risk patients. In this study, we present the first outcome of echocardiographic midterm using a new second-generation transcatheter aortic valve implantation system, the J-Valve system (Jie Cheng Medical Technologies, Suzhou, China), in patients with aortic stenosis or aortic regurgitation. ⋯ The J-Valve system exhibits a convincing midterm performance and is a safe and feasible procedure with low perioperative and postoperative complications.
-
J. Thorac. Cardiovasc. Surg. · Jul 2017
A systematic approach to improve the outcomes of type A aortic dissection.
The aims of this study are to evaluate the outcomes and trends of contemporary emergency surgery for acute type A aortic dissection on the basis of a systematic approach and to assess the impact of temporary aortic crossclamping during systemic cooling on early and late outcomes. ⋯ Emergency surgery for acute type A aortic dissection based on our systematic approach demonstrated excellent early and late outcomes. The temporary aortic crossclamping during cooling decreased the operation time without increasing early and late adverse events.
-
J. Thorac. Cardiovasc. Surg. · Jul 2017
Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection.
Although generally better outcomes are reported in patients undergoing early repair of type A aortic dissection, patients who survive the first 48 hours self-select themselves toward better outcomes as well. Malperfusion is another important determinant of outcome in these patients. The aim of this study was to examine the hypothesis that malperfusion, not the timing of operation, is the dominant determinant of outcome in repair of type A aortic dissection. ⋯ Malperfusion at presentation rather than timing of intervention is the major risk factor of death both in the hospital and at long-term follow-up in patients undergoing surgery for type A aortic dissection.
-
J. Thorac. Cardiovasc. Surg. · Jul 2017
V-shape noncoronary sinus remodeling in ascending aortic aneurysm and aortic root ectasia.
The study objective was to describe our initial experience performing a V-shaped single sinus remodeling procedure in patients with ascending aortic aneurysm and moderate aortic root ectasia. ⋯ The V-shaped resection of the noncoronary sinus is a viable option for patients with moderate aortic root enlargement. This technique reduces aortic root diameter, cross-sectional area, and wall tension. We offer this technique as another option in the surgeon's armamentarium.