The Annals of thoracic surgery
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Multicenter Study Observational Study
A Single-Center Experience of 900 Interhospital Transports on Extracorporeal Membrane Oxygenation.
The dawning of the extracorporeal membrane oxygenation (ECMO)-2 era, with the potential of decentralizing ECMO treatment, has stressed the need for research into the safety of ECMO transportations. The aim of this study was to (1) provide a comprehensive summary of transport arrangements and complications at a high-volume ECMO center, (2) determine predictors of severe complications occurring during transport, and (3) determine transport-related predictors of mortality. ⋯ Severe complications during ECMO transportation recurrently occurred but did not affect mortality. We conclude that interhospital ECMO transportation is safe, when conducted by an experienced center, and patients should be transported for treatment at a high-volume ECMO center in accordance with the hub-and-spoke model whenever feasible.
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There is an increased risk of medical errors overnight compared with the day, secondary to fatigue, paucity of resources, and decreased staffing. Whether this increased risk extends to liberation from mechanical ventilation is controversial. We evaluated the relationship between length of intubation and differences between diurnal and nocturnal extubation. ⋯ Nocturnal extubation was associated with increased mortality only in the group of patients receiving more than 24 hours of mechanical ventilation.
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Controversy exists over the optimal neoadjuvant therapy in patients with locally advanced esophageal cancer (EC). Although most groups favor neoadjuvant chemoradiation (nCRT), some prefer preoperative chemotherapy (nCT) without radiation. The objective of this study was to compare outcomes in EC patients undergoing either regimen, followed by surgery. ⋯ For adenocarcinoma patients undergoing surgery for EC, nCRT leads to increased local tumor response compared with nCT alone but with no difference in survival. For squamous carcinoma patients nCRT appears to improve CSS compared with nCT. For patients with locally advanced EC targeted neoadjuvant regimens should be used depending on tumor histology.
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Comparative Study
Functional Outcomes of Type I Bicuspid Aortic Valve Repair With Annular Stabilization: Subcommissural Annuloplasty Versus External Subannular Aortic Ring.
In bicuspid aortic valve patients with nonaneurysmal root (<45 mm) and severe aortic insufficiency (AI), external subannular aortic ring (ESAR) is being increasingly utilized for annular stabilization, compared with traditional subcommissural annuloplasty (SCA). To this date, there is no comparative study assessing functional equivalence or superiority of ESAR over SCA. ⋯ In addition to providing equivalent and excellent freedom from AI, ESAR also renders a more robust annular reduction than SCA, along with improved transvalvular gradients.