The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2019
Off-label use of duct occluder in transcatheter closure of secundum atrial septal defect with no rim to right pulmonary vein.
Transcatheter closure is usually contraindicated in secundum atrial septal defect with no rim to right pulmonary vein. The morphology of an atrial septal defect is special in these patients, and the off-label use of a duct occluder might make transcatheter closure possible with the assistance of a personalized heart model. However, the related data are absent. This study was performed to investigate the off-label use of a duct occluder in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. ⋯ By using a personalized heart model, the off-label use of a duct occluder is feasible and safe in the transcatheter closure of an atrial septal defect with no right pulmonary vein rim. Further research is required to evaluate the long-term outcomes.
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J. Thorac. Cardiovasc. Surg. · Apr 2019
CommentThe long-term safety and efficacy of concomitant Cox maze procedures for atrial fibrillation in patients without mitral valve disease.
Newly published guidelines made the highest level recommendation for surgical treatment for atrial fibrillation. However, the number of patients without a mitral valve procedure with atrial fibrillation who are treated with concomitant surgical ablation is still low (15%-25%), because surgeons are reluctant to perform procedures in patients who would not otherwise require left atriotomy. The purpose of this study was to compare the outcomes of concomitant Cox maze with and without mitral valve procedures. ⋯ The Cox maze procedure is safe and effective with comparable outcomes when performed concomitant to mitral valve or non-mitral valve surgery. Surgeons should base the decision to perform surgical ablation procedures on atrial fibrillation pathophysiology and the benefit to patients, not on the type of concomitant procedure.
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J. Thorac. Cardiovasc. Surg. · Apr 2019
Observational StudyA decade of interfacility extracorporeal membrane oxygenation transport.
Extracorporeal membrane oxygenation (ECMO) is used to provide support for patients with cardiopulmonary failure. Best available medical management often fails in these patients and referring hospitals have no further recourse for escalating care apart from transfer to a tertiary facility. In severely unstable patients, the only option might be to use ECMO to facilitate safe transport. This study aimed to examine the characteristics and outcomes of patients transported while receiving ECMO. ⋯ Interfacility transport during ECMO was shown to be safe and effective with minimal complications and favorable outcomes when performed at an experienced referral center using stringently applied protocols.
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J. Thorac. Cardiovasc. Surg. · Apr 2019
Observational StudyDeveloping skills for thoracic aortic surgery with hypothermic circulatory arrest.
To examine the performance curves of 8 early-career aortic surgeons with the use of hypothermic circulatory arrest (HCA) and to analyze the impact of the learning curve on perioperative outcomes. ⋯ Early-career surgeons can safely perform operations with HCA from the initiation of their practice. The cumulative sum analysis method is valuable for monitoring competence in aortic surgery and could prove useful in structuring training programs.
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J. Thorac. Cardiovasc. Surg. · Apr 2019
Outcomes related to immediate extubation after stage 1 Norwood palliation for hypoplastic left heart syndrome.
Immediate extubation may have outcome benefits when judiciously instituted after neonatal congenital cardiac surgery. We sought to evaluate the outcomes of immediate extubation specifically in neonates undergoing stage 1 Norwood palliation of hypoplastic left heart syndrome. ⋯ Immediate extubation strategy was safely accomplished in one-fifth of this cohort of hypoplastic left heart syndrome. A larger cohort may delineate the determinants of immediate extubation and its benefits in infants undergoing stage 1 single ventricle palliation.