The Annals of thoracic surgery
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The objective of this study was to assess the fate at long term of mild-to-moderate functional tricuspid regurgitation (TR) left untreated at the time of mitral valve repair in patients with dilated cardiomyopathy. ⋯ A significant number of dilated cardiomyopathy patients with mild-to-moderate TR left untreated at the time of mitral repair show important TR at follow-up. In this setting, a more aggressive policy should be used taking into consideration the degree of annular dilatation and the function of the right ventricle and not simply the grade of TR.
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Given substantial advances in venovenous extracorporeal membrane oxygenation (ECMO) technology, long-term support is increasingly feasible. Although the benefits of short-term ECMO as a bridge to recovery in acute respiratory distress syndrome (ARDS) are well described, the utility and outcomes of long-term support remain unclear. ⋯ Previously, long-term ECMO support was thought to be associated with unfavorable outcomes. This study, however, may provide support for the efficacy of ECMO support even for 3 weeks or more as a bridge to recovery or transplantation.
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The Society of Thoracic Surgeons (STS) quality benchmarks guide clinical outcome improvement in cardiac surgery. Failure to rescue (FTR) from postoperative morbidity is a proposed metric of program quality. We examined the effect of a quality improvement initiative guided by STS quality measures on outcomes and FTR. ⋯ Implementation of quality improvement initiatives significantly improves outcomes without affecting FTR rates. Further study is needed to determine if FTR provides additive value to quality assessment over existing STS metrics.
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Multicenter Study Observational Study
Nadir Hematocrit on Bypass and Rates of Acute Kidney Injury: Does Sex Matter?
Reports have associated nadir hematocrit (Hct) on cardiopulmonary bypass with the occurrence of renal dysfunction. Recent literature has suggested that women, although more often exposed to lower nadir Hct, have a lower risk of postoperative renal dysfunction. We assessed whether this relationship held across a large multicenter registry. ⋯ Lower nadir Hct was associated with an increased risk of AKI, and the effect appears to be stronger among men than women. Understanding of the mechanism underlying this association remains uncertain, although these results suggest the need to limit exposure to lower nadir Hct, especially for male patients.