The Annals of thoracic surgery
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Recent policy interventions have reduced payments to hospitals with higher-than-predicted risk-adjusted readmission rates. However, whether readmission rates reliably discriminate deficiencies in hospital quality is uncertain. We sought to determine the reliability of 30-day readmission rates after cardiac operations as a measure of hospital performance and evaluate the effect of hospital caseload on reliability. ⋯ The vast majority of hospitals do not achieve a minimum acceptable level of reliability for 30-day readmission rates. Despite recent enthusiasm, readmission rates are not a reliable measure of hospital quality in cardiac surgery.
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Meta Analysis Comparative Study
Comparison of graft patency between off-pump and on-pump coronary artery bypass grafting: an updated meta-analysis.
Currently, off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) are 2 well-established therapeutic strategies for patients with coronary artery disease, and debate regarding which strategy provides superior graft patency is ongoing. The current study is a meta-analysis of randomized controlled trials that compared the graft patency between OPCAB and ONCAB. ⋯ Meta-analysis of currently available randomized controlled trials on graft patency shows that ONCAB reduces the incidence of SVG graft occlusion significantly but does not affect LIMA and radial artery graft patency compared with OPCAB.
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Surgical techniques for aortic valve (AV) repair are directed toward restoring normal structural relationships in the aortic root and rely on detailed assessment of root and valve anatomy. Noninvasive three-dimensional (3D) imaging and modeling may assist in patient selection and operative planning. ⋯ High-resolution 3D models of the in vivo normal human aortic root and valve were generated using 3D echocardiography. Quantitative 3D models and analysis may assist in characterization of pathology and decision making for AV repair.
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Valve-sparing aortic root replacement (VSARR) is an alternative to traditional composite valve graft (CVG) root replacement. We examined early and midterm outcomes after VSARR. ⋯ Valve-sparing aortic root replacement can have excellent early and respectable midterm outcomes, even when combined with arch repair. Further follow-up remains necessary to evaluate the long-term durability of VSARR.
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Review Case Reports
Direct injury to right coronary artery in patients undergoing tricuspid annuloplasty.
Direct injury to the right coronary artery as a result of reparative operation on the tricuspid valve is a rare, probably underdiagnosed, but serious complication, which often involves dramatic clinical consequences. So far, only five cases have been described in the literature. ⋯ Occlusion of the right coronary artery in patients undergoing tricuspid annuloplasty is a rare complication that may occur if great annulus dilatation is present, thus altering both normal annular geometry and the relationship between the right coronary artery and the tricuspid annulus, particularly when DeVega annuloplasty is performed. Such an entity should be considered in the immediate postoperative period in an unstable patient, especially when complementary tests support this diagnosis. Prompt recognition and treatment can positively affect the patient's outcome, most often by means of an emergency revascularization strategy.