The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Morbidity and mortality prediction in pediatric heart surgery: Physiological profiles and surgical complexity.
Outcome prediction for pediatric heart surgery has focused on mortality but mortality has been significantly reduced over the past 2 decades. Clinical care practices now emphasize reducing morbidity. Physiology-based profiles assessed by the Pediatric Risk of Mortality (PRISM) score are associated with new significant functional morbidity detected at hospital discharge. Our aims were to assess the relationship between new functional morbidity and surgical risk categories (Risk Adjustment for Congenital Heart Surgery [RACHS] and Society for Thoracic Surgery Congenital Heart Surgery Database Mortality Risk [STAT]), measure the performance of 3-level (intact survival, survival with new functional morbidity, or death) and 2-level (survival or death) PRISM prediction algorithms, and assess whether including RACHS or STAT complexity categories improves the PRISM predictive performance. ⋯ Both mortality and new, functional morbidity are important outcomes associated with surgical complexity and can be predicted using PRISM algorithms. Adding surgical complexity to the physiologic profiles does not improve predictor performance.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Computational fluid dynamics simulation of the right subclavian artery cannulation.
The purpose of this study was to evaluate the efficacy of right subclavian artery cannulation using computational fluid dynamics. ⋯ Right subclavian artery cannulation was cerebroprotective, especially on the right side.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Implications and outcomes of cardiac grafts refused by pediatric centers but transplanted by adult centers.
According to Organ Procurement Transplant Network policy, hearts from donors age <18 years are offered to pediatric recipients before being offered to adults of the same health status. We aimed to analyze differences in the use of adolescent donor hearts between adult and pediatric candidates and also to analyze the outcomes of pediatric candidates in which an adolescent donor heart was refused and later used in an adult recipient. ⋯ A significant number of adolescent donor hearts that are refused by pediatric centers result in excellent post-transplantation outcomes in adult recipients. One in 10 pediatric candidates died on the waitlist after refusal of these hearts used by adult recipients. This warrants careful evaluation of the refusal criteria used by pediatric centers. Encouragingly, there now appears to be a trend toward an increased use of adolescent donor hearts by pediatric centers.
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J. Thorac. Cardiovasc. Surg. · Aug 2017
Survival impact of postoperative therapy modalities according to margin status in non-small cell lung cancer patients in the United States.
Unlike complete (R0) resection guidelines, current National Comprehensive Cancer Network (NCCN) adjuvant therapy guidelines after incomplete (R1/R2) resection of non-small cell lung cancer (NSCLC) are based on low-level evidence. We attempted to validate them. ⋯ NCCN adjuvant therapy guidelines after complete resection, based on high-level evidence, are validated, but not guidelines for patients with incompletely resected early-stage NSCLC, which are based on low-level evidence. Monomodality postoperative radiotherapy was not validated for any stage. Specific studies are needed to determine optimal management after incomplete resection.