The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2019
Comparative StudyDisparity between recent graduates' and experienced surgeons' assessment of time to operative independence.
In cardiothoracic surgery, little data exist on the transition to operative independence. We aimed to compare current perceptions of operative autonomy of junior cardiothoracic surgeons and senior colleagues who oversee transitional years. ⋯ Most junior surgeons perceived operative independence with basic thoracic, basic cardiac, and complex cardiac operations earlier in their surgical career than that reported by senior colleagues. Objective measures of operative independence may clarify this discrepancy. This study establishes a baseline by which to compare the effects of integrated 6-year programs on operative independence. The discrepant perceptions may have implications for how training programs prepare graduates for the transition to independent practice.
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J. Thorac. Cardiovasc. Surg. · May 2019
Observational StudyThree-dimensional mitral valve structure in predicting moderate ischemic mitral regurgitation improvement after coronary artery bypass grafting.
Focusing on 3-dimensional mitral valve structure, this study investigated predictors for moderate ischemic mitral regurgitation (IMR) improvement after off-pump coronary artery bypass grafting (OPCAB). ⋯ Preoperative moderate IMR can be improved by OPCAB in selected patients. Less annular flattening and P3 leaflet tethering may predict improvement of moderate IMR after OPCAB, suggesting that the annular nonplanar saddle shape and less leaflet tethering toward P3 segment are important for the prognosis of moderate IMR.
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J. Thorac. Cardiovasc. Surg. · May 2019
The cost burden of clinically significant esophageal anastomotic leaks-a steep price to pay.
The purpose of this retrospective cohort study was to evaluate resource consumption of clinically significant esophageal anastomotic leaks. ⋯ Grade III to IV esophageal anastomotic leaks more than double the cost of an esophagectomy and have a significant cost burden. Focus should be placed on preventative measures to avoid leaks at the time of the index operation.
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J. Thorac. Cardiovasc. Surg. · May 2019
Observational StudyPredicted clinical factors associated with the intensive care unit length of stay after total cavopulmonary connection.
A longer length of stay (LOS) in the intensive care unit (ICU) after the total cavopulmonary connection (TCPC) is thought to be a predictive sign of late Fontan failure. This study was performed to determine the clinical risk factors for ICU LOS. ⋯ Patients with hypoplastic left heart syndrome and anomalous systemic venous drainage had longer ICU LOS. Extended cyanosis and elevated pulmonary artery pressure affect the ICU LOS. Special care should be provided during the initial postoperative phase in patients with such risk factors.
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J. Thorac. Cardiovasc. Surg. · May 2019
Hybrid coronary revascularization: Midterm outcomes of robotic multivessel bypass and percutaneous interventions.
The purpose of this study was to investigate the outcomes of patients undergoing advanced hybrid coronary revascularization, defined as robotic beating-heart multivessel totally endoscopic coronary artery bypass combined with percutaneous coronary intervention. ⋯ Advanced hybrid coronary revascularization is a safe and less-invasive approach with short hospital stay and good midterm outcomes.