The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Comparative StudyA pulsatile hemodynamic evaluation of the commercially available bifurcated Y-graft Fontan modification and comparison with the lateral tunnel and extracardiac conduits.
Fontan completion, resulting in a total cavopulmonary connection, is accomplished using a lateral tunnel, extracardiac conduit, or bifurcated Y-graft. The use of Y-grafts is hypothesized to provide symmetric hepatic blood flow distribution to the lungs, a factor related to pulmonary arteriovenous malformations. The present study evaluates the hemodynamic performance of the largest commercially available Y-graft cohort to date, highlights 6 representative cases, and compares commercially available Y-graft performance with lateral tunnel/extracardiac conduit connections. ⋯ Commercially available Y-grafts do not inherently provide more balanced hepatic flow distribution than lateral tunnel/extracardiac conduit connections, which are more energetically favorable and less sensitive to pulmonary artery stenosis. Graft type should be considered on an individual basis because hemodynamic performance is based on a combination of factors, including pulmonary flow distribution, pulmonary artery stenosis, and superior vena cava positioning.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Editorial Biography Historical ArticleHistorical perspectives of The American Association for Thoracic Surgery: Joel D. Cooper.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Multicenter Study Clinical TrialEarly outcomes after isolated aortic valve replacement with rapid deployment aortic valve.
Minimal access aortic valve replacement is associated with favorable clinical outcomes; however, several meta-analyses have reported significantly longer crossclamp times compared with a full sternotomy. We examined the procedural and early safety outcomes after isolated rapid deployment aortic valve replacement by surgical approach in patients enrolled in the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve trial. ⋯ These data suggest that isolated rapid deployment aortic valve replacement through an upper hemisternotomy can lead to shorter crossclamp times than has been reported historically in the literature. This may facilitate minimal access aortic valve replacement by eliminating the issue of prolonged crossclamp times. Further, low in-hospital mortality and new permanent pacemaker implant rates were observed regardless of surgical approach.
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J. Thorac. Cardiovasc. Surg. · Jun 2016
Evaluation of robotic cardiac surgery simulation training: A randomized controlled trial.
To compare the currently available simulation training modalities used to teach robotic surgery. ⋯ We have completed the first randomized controlled trial to objectively compare the different training modalities of robotic surgery. Our data demonstrate the significant benefits of wet lab and virtual reality robotic simulation training and highlight key differences in current training methods. This study can help guide training programs in investing resources in cost-effective, high-yield simulation exercises.