The Annals of thoracic surgery
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Predictive factors for red blood cell transfusion in children undergoing noncomplex cardiac surgery.
Red blood cell (RBC) transfusion is frequently required in pediatric cardiac surgery and is associated with altered outcome and increased costs. Determining which factors predict transfusion in this context will enable clinicians to adopt strategies that will reduce the risk of RBC transfusion. This study aimed to assess predictive factors associated with RBC transfusion in children undergoing low-risk cardiac surgery with cardiopulmonary bypass (CPB). ⋯ The present study identified several factors that were significantly associated with perioperative RBC transfusion. Based on these factors, we designed a predictive score that can be used to develop a patient-based blood management program with the aim of reducing the incidence of RBC transfusion.
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Postoperative death is an important outcome after esophagectomy, and the Centers for Medicare & Medicaid Services currently uses 30-day mortality as a quality indicator for this operation. However, 30-day mortality may underestimate a patient's true postoperative death risk. The purpose of this study was to evaluate different mortality definitions using a large registry of patients undergoing esophagectomy for cancer. ⋯ There are clinically meaningful differences between postoperative mortality definitions after esophagectomy. Thirty-day mortality significantly underestimates a patient's true risk of death because this number more than doubles at 90 days in this elderly, Medicare population. Although neither 90-day nor 30-day mortality are adequate quality measures after esophagectomy, 90-day mortality is a better outcome measure because it provides a better understanding of true death risk for the surgeon and patient.
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This study aimed to predict variation in the thoracic surgery workforce requirements with the introduction of a national chest computed tomographic (CT) screening program for individuals at high risk of lung cancer. ⋯ With the implementation of a CT screening program there will be an increase in operable lung cancers, resulting in increased surgical volume. A national strategy for the thoracic surgery workforce is necessary to ensure that an appropriate number of surgeons are being trained to meet the future needs of the national population.
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Duration and magnitude of vasopressor support predicts poor outcome after infant cardiac operations.
The vasoactive inotrope score (VIS) is a sum of the total vasopressor dose at a single point in time. Incorporating duration and magnitude of vasopressor requirements during the postcardiac surgical period could improve VIS sensitivity for predicting poor outcome. ⋯ Incorporating magnitude and duration of postoperative vasopressor support into the VIS improves its sensitivity for predicting poor outcome.
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Observational Study
Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacement.
Valve sparing root replacement (VSRR) and aortic valve repair (AVr) is an attractive treatment option compared with composite valve and root replacement (Bentall procedure) for patients with aortic root dilatation with or without aortic valve disease. While aortic valve preservation reduces the risk of valve-related complications, little is known about echocardiographic differences at follow-up between these 2 strategies. ⋯ Valve sparing root replacement with AV repair provides similar mid-term echocardiographic and clinical outcomes compared with the Bentall.