The Annals of thoracic surgery
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Comparative Study
Technical performance scores in congenital cardiac operations: a quality assessment initiative.
Technical performance in congenital cardiac operations and its association with clinical outcomes was previously examined in infants and neonates. The purpose of this study was the development and implementation of a system for measuring technical performance in the majority of congenital cardiac operations to be used as a surgeon's self-assessment tool. ⋯ The development and implementation of a broad technical performance self-assessment system for congenital cardiac operations is possible. Based on this scoring system, the impact of a less than optimal (2 or 3) technical score depends on case risk category, with higher mortality in the higher risk group, and increased resource use for lower risk procedures.
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Comparative Study
Fontan conversion to one and one half ventricle repair.
In patients with a modified Fontan connection, particularly the right atrial to right ventricular connection, the pulmonary ventricle may enlarge with time. ⋯ Fontan conversion to one and one half ventricle repair is feasible in selected patients with a failing Fontan circulation. Operation can be performed with low early mortality. Arrhythmia surgery should be performed routinely. Quality of life is excellent.
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Multicenter Study Comparative Study
Who performs complex noncardiac thoracic surgery in United States academic medical centers?
We hypothesized that general thoracic surgeons (GTS) predominantly perform complex noncardiac thoracic surgery in academic hospitals compared with cardiac surgeons (CS), general surgeons, and surgical oncologists. ⋯ In academic hospitals, noncardiac thoracic surgery is performed mostly by GTS, supporting academic GTS as a distinct specialty. These results may help determine hospital referral and credentialing policies, and plan general and cardiothoracic surgery residency curriculum.
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Comparative Study
Valve-sparing root reconstruction does not compromise survival in acute type A aortic dissection.
The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures. ⋯ Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.
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Comparative Study
Thoracoscopic talc versus tunneled pleural catheters for palliation of malignant pleural effusions.
A malignant pleural effusion (MPE) is a late complication of malignancy that affects respiratory function and quality of life. A strategy for palliation of the symptoms caused by MPE should permanently control fluid accumulation, preclude any need for reintervention, and limit hospital length of stay (LOS). We compared video-assisted thorascopic (VATS) talc insufflation with placement of a tunneled pleural catheter (TPC) to assess which intervention better met these palliative goals. ⋯ TPC placement was associated with a significantly reduced postprocedure and overall LOS compared with VATS talc. Also, TPC placement was associated with significantly fewer ipsilateral reinterventions. Placement of TPC should be considered for palliation of MPE-associated symptoms.