The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 2020
Acute coronary artery obstruction following surgical repair of congenital heart disease.
Acute coronary artery obstruction is a rare complication of congenital heart disease surgery but imposes a high burden of morbidity and mortality. Previous case series have described episodes in specific congenital heart lesions or surgical repairs but have not examined the complication in all-comers to congenital heart surgery. We hypothesize that shorter time from a clinically recognized postoperative sentinel event suggestive of coronary ischemia to diagnosis of coronary obstruction is associated with improved clinical outcomes. ⋯ Time from clinically relevant postoperative sentinel event to diagnosis of coronary artery obstruction by angiography was associated with transplant-listing-free survival. Clinicians should maintain a high index of suspicion for coronary obstruction and consider early catheterization and coronary angiography for patients in whom post-operative coronary compromise is suspected.
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J. Thorac. Cardiovasc. Surg. · May 2020
Goal-directed resuscitation following cardiac surgery reduces acute kidney injury: A quality initiative pre-post analysis.
Acute kidney injury (AKI) occurs in 20% of patients following cardiac surgery. To reduce AKI in our institution, we instituted a quality improvement (QI) initiative using a goal-directed volume resuscitation protocol. Our protocol was designed to achieve quantifiable physiologic goals (eg, cardiac index > 2.5 L/min/m2, mean arterial pressure > 65 mm Hg) using fluid and vasoactive agents. The objective of this study was to evaluate AKI in the pre- and post-QI eras, hypothesizing that AKI incidence would decrease in the post-QI era. ⋯ A goal-directed volume resuscitation protocol centered on patient fluid responsiveness is associated with significantly reduced risk for AKI after cardiac surgery. Protocol-driven approaches should be employed in intensive care units to improve outcomes.
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J. Thorac. Cardiovasc. Surg. · May 2020
Medical student perceptions of a career in cardiothoracic surgery: Results of an institutional survey.
Recruiting medical students to cardiothoracic surgery is critical given new training paradigms and projected cardiothoracic surgeon shortages. This study characterizes current perceptions and exposure to cardiothoracic surgery among all levels of medical students. ⋯ Although medical students report early interest in cardiothoracic surgery because of intellectual stimulation and patient care attributes, lack of early exposure and perceived poor lifestyle negatively affect interest in the field. Early interaction between students and cardiothoracic faculty/trainees along with early exposure opportunities may increase recruitment.
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J. Thorac. Cardiovasc. Surg. · May 2020
In vivo implantation of 3-dimensional printed customized branched tissue engineered vascular graft in a porcine model.
The customized vascular graft offers the potential to simplify the surgical procedure, optimize physiological function, and reduce morbidity and mortality. This experiment evaluated the feasibility of a flow dynamic-optimized branched tissue engineered vascular graft (TEVG) customized based on medical imaging and manufactured by 3-dimensional (3D) printing for a porcine model. ⋯ Our animal model demonstrates the feasibility of designing and implanting image-guided, 3D-printed, customized grafts. These grafts can be designed to optimize both anatomic fit and hemodynamic properties. This study demonstrates the tremendous potential structural and physiological advantages of customized TEVGs in cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · May 2020
Does one size fit all? An evaluation of the 2018 Leapfrog Group minimal hospital and surgeon volume thresholds for lung surgery.
In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. ⋯ Hospital volume has a greater effect on morbidity and mortality than surgeon volume especially for older-sicker patients, suggesting that Leapfrog Group volume guidelines should emphasize hospital volume over surgeon volume and may be less relevant for younger-healthier patients.