The Annals of thoracic surgery
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Multicenter Study
Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS Congenital Heart Surgery Database.
Failure to rescue (FTR; the probability of death after a complication) has been adopted as a quality metric in adult cardiac surgery, in which it has been shown that high-performing centers with low mortality rates do not have fewer complications, but rather lower mortality in those who experience a complication (lower FTR). It is unknown whether this holds true in pediatric heart surgery. We characterized the relationship between complications, FTR, and mortality in this population. ⋯ This analysis suggests that hospitals with low mortality rates do not have fewer complications after pediatric heart surgery, but instead have lower mortality in those who experience a complication (lower FTR). Further investigation into FTR as a quality metric in pediatric heart surgery is warranted.
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The purpose of this work was to assess career demographics, professional activities, and career satisfaction of board-certified female cardiothoracic surgeons in the United States, 50 years after certification of the first women diplomats by the American Board of Thoracic Surgery (ABTS). ⋯ Women represent a minority of cardiothoracic surgeons in the United States. The numbers in academic versus private practice are roughly equal, with high levels of job satisfaction in both. Importantly, 90% of surveyed women remain in practice and are academically productive; 50% entered the profession in the past 10 years. The exponential increase in the number of women in the field over the past 10 years provides optimism for continued recruitment.
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Extracorporeal membrane oxygenation (ECMO) has demonstrated utility in the management of adult respiratory failure refractory to mechanical ventilation. The recent introduction of a bicaval dual-lumen ECMO cannula has improved the efficiency of venovenous ECMO and has enabled the concept of full extracorporeal respiratory support in place of mechanical ventilation. Standard placement of this cannula through the right internal jugular vein is particularly troublesome in individuals of short stature, because of excess cannula length. We describe a method for cannula placement through the left subclavian vein that is well suited for smaller patients and convenient for patient mobility.
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Randomized Controlled Trial Multicenter Study Comparative Study
Coronary artery bypass graft patency: residents versus attending surgeons.
Data are limited regarding the patency of coronary artery bypass grafts performed by residents versus attending surgeons. ⋯ Surgeons in training perform coronary artery bypass surgery without compromising graft patency or patient outcomes. Ongoing evaluation of residents' performance and surgical outcomes is needed, given the major changes that are occurring in residency training.
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Randomized Controlled Trial
Amiodarone significantly decreases atrial fibrillation in patients undergoing surgery for lung cancer.
Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing thoracic surgery. Although postoperative atrial fibrillation often is regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including transient or permanent stroke, acute myocardial infarction, and death. ⋯ Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for patients with lung cancer undergoing surgery. It significantly reduced the incidence of postoperative atrial fibrillation.