The Annals of thoracic surgery
-
In the late 1990s, several federal government health policy decisions threatened the viability of thoracic surgery as a specialty. To respond to such decisions, active participation in political processes was given extremely high priority by the Executive Committee of The Society of Thoracic Surgeons (STS). Creation of the STS Political Action Committee (STS-PAC) in 1997 was a part of the platform of participation. ⋯ The STS-PAC is a principal component of the STS' advocacy armamentarium. Despite the many successes of the STS-PAC, with even modest contributions by more STS members, the STS-PAC could become a leading medical PAC, and would give the STS an even stronger presence and voice in Washington, DC. Clearly, contributing to the STS-PAC provides STS members the opportunity to have a voice and an impact on health policy and the care of their patients.
-
Recent data suggest that hemolysis contributes to left ventricular assist device (LVAD) thrombosis, but the mechanism is unknown. In a clinical study, we measured plasma free hemoglobin (pfHgb) and the incidence of LVAD thrombosis. In an in vitro study, we examined biophysical relationships between shear stress, pfHgb and von Willebrand factor (vWF) metabolism toward understanding mechanisms of LVAD thrombosis. ⋯ These are the first data to demonstrate mechanistic relationships between subclinical hemolysis and a procoagulant state during continuous-flow LVAD support. Patients with high pfHgb and LDH were more likely to develop LVAD thrombosis. In vitro experiments demonstrated that free hemoglobin inhibited ADAMTS-13, protected vWF from degradation, increased vWF clotting function, and created a procoagulant state. As such, pfHgb may be a clinical target to prevent LVAD thrombosis.
-
Studies reporting the benefits of video-assisted thoracoscopic surgery (VATS) lung cancer resection over thoracotomy have been subject to selection bias. We evaluated patient and hospital characteristics associated with type of surgery and the independent effect of VATS on outcomes. ⋯ Numerous patient- and hospital-related variables that affect morbidity and mortality also affect whether a patient undergoes VATS or open lung resection. Studies evaluating VATS must account more accurately for selection bias and adjust for these confounders.
-
Extended postoperative chemoprophylaxis is effective in reducing venous thromboembolism (VTE) among general surgical patients. We hypothesized that implementation of the Caprini risk assessment model (RAM) would reduce VTE rates among patients undergoing lung and esophageal cancer surgery. ⋯ This study demonstrates a trend toward decreased symptomatic VTE after Caprini RAM implementation, as demonstrated among high-risk cancer patients. The absence of bleeding complications and high provider and patient adherence to VTE RAM support the safety and feasibility of a VTE prevention protocol in thoracic surgery patients.
-
The Society of Thoracic Surgeons Congenital Heart Surgery Database is a comprehensive registry of clinical outcomes that captures almost all pediatric cardiac surgical operations in the United States. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. ⋯ The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operation groups performed from January 2013 through December 2016. This analysis documents the overall aggregate Operative Mortality (interquartile range among all participating programs) for the following procedural groups: off-bypass coarctation repair, 1.3% (0.0% to 1.4%%); ventricular septal defect repair, 0.6% (0.0% to 0.9%); tetralogy of Fallot repair, 1.1% (0.0% to 2.0%); complete atrioventricular canal repair, 2.7% (0.0% to 4.4%); arterial switch operation, 2.2% (0.0% to 2.9%); arterial switch operation and ventricular septal defect repair, 5.1% (0.0% to 8.3%); Glenn/HemiFontan, 2.1% (0.0% to 3.1%); Fontan operation, 1.1% (0.0% to 0.0%); truncus arteriosus repair, 10.1% (0.0% to 15.4%); and Norwood procedure, 15.8% (9.0% to 25.0%).