The Annals of thoracic surgery
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Comparative Study
Open Repair of Thoracoabdominal Aortic Aneurysm in Patients 50 Years Old and Younger.
Evolving endovascular approaches to thoracoabdominal aortic aneurysm (TAAA) repair are attractive alternatives to the "gold standard" of conventional open TAAA repair. However, open repair may be more suitable for younger patients. We compared the outcomes of open TAAA repair in younger (≤50 years) and older (>50 years) patients to evaluate operative risk in younger patients. ⋯ Early outcomes of open TAAA repair were excellent for patients 50 years old or younger, despite the fact that these patients typically required extensive repairs.
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Case Reports
Laparoscopic Repair of an Intrapericardial Diaphragmatic Hernia After Convergent Maze Procedure.
The convergent maze procedure (CMP) is a new minimally invasive technique for the surgical treatment of atrial fibrillation (AF). Recently, multiple groups have published excellent results and few adverse events with CMP. ⋯ This adverse event was managed successfully by laparoscopic repair of the hernia and the use of a polytetrafluoroethylene mesh closure with hepatic buttress, achieving an excellent result. With the expanding use of CMP for the treatment of AF, awareness of this adverse event and its appropriate management are increasingly important.
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Comparative Study
Selective En Masse Ligation of the Thoracic Duct to Prevent Chyle Leak After Esophagectomy.
Postoperative chylothorax remains an important cause of reoperation and prolonged hospital stay after esophagectomy for the treatment of esophageal carcinoma. Chylothorax is potentially life threatening and difficult to manage. The benefit of routine thoracic duct ligation is controversial. A promising alternative is to identify chyle leaks at the time of esophagectomy and perform the ligation selectively. We developed a novel technique to identify chyle leak at the time of esophagectomy and compared it with routine ligation of thoracic duct. ⋯ Our method of selective en masse ligation of the thoracic duct during esophagectomy was feasible and safe and was associated with reduced rates of postoperative chylothorax.
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Development of curricula that appropriately progress a resident from medical school graduate to fully trained cardiothoracic surgeon is a key challenge for integrated cardiothoracic training programs. This study examined variability and perceived challenges in integrated curricula. ⋯ Significant variation exists in integrated cardiothoracic surgery curricula. Optimization of rotations, access to surgical experience, and integration with general surgery appear to be the most significant perceived challenges. These data suggest that optimization of early clinical and surgical experience within institutions could improve trainee preparedness for senior cardiothoracic surgery training.