The Annals of thoracic surgery
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Multicenter Study Comparative Study
Time-varying survival benefit of radial artery versus vein grafting: a multiinstitutional analysis.
A survival benefit of radial artery use versus saphenous vein grafting in coronary artery bypass grafting (CABG) has been reported. We aimed to elucidate the relative radial artery survival benefit as a function of time after surgery from two independent CABG series. ⋯ Despite substantial differences in radial artery use patterns during a 15-year period, our analysis in large propensity-matched radial artery and saphenous vein cohorts yielded remarkably similar, time-varying radial artery to saphenous vein survival benefit at both institutions. These converging findings based on two independent patient series extend currently available objective evidence in support of a radial artery survival advantage in CABG.
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Surgical techniques for aortic valve (AV) repair are directed toward restoring normal structural relationships in the aortic root and rely on detailed assessment of root and valve anatomy. Noninvasive three-dimensional (3D) imaging and modeling may assist in patient selection and operative planning. ⋯ High-resolution 3D models of the in vivo normal human aortic root and valve were generated using 3D echocardiography. Quantitative 3D models and analysis may assist in characterization of pathology and decision making for AV repair.
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Right heart failure is poorly understood and treated. In left heart failure, ventricular restraint can reverse pathologic left ventricular remodeling. The effect of restraint in right heart failure, however, is not known. We hypothesize that ventricular restraint can be applied selectively to the right ventricle (RV) to promote RV reverse remodeling. ⋯ A model of ischemic right heart failure was successfully created. Selective RV restraint results in improved mechanical efficiency, decreased wall stress, and improved EF. The benefits of restraint in right heart failure warrant further investigation.
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Recent policy interventions have reduced payments to hospitals with higher-than-predicted risk-adjusted readmission rates. However, whether readmission rates reliably discriminate deficiencies in hospital quality is uncertain. We sought to determine the reliability of 30-day readmission rates after cardiac operations as a measure of hospital performance and evaluate the effect of hospital caseload on reliability. ⋯ The vast majority of hospitals do not achieve a minimum acceptable level of reliability for 30-day readmission rates. Despite recent enthusiasm, readmission rates are not a reliable measure of hospital quality in cardiac surgery.
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Valve-sparing aortic root replacement (VSARR) is an alternative to traditional composite valve graft (CVG) root replacement. We examined early and midterm outcomes after VSARR. ⋯ Valve-sparing aortic root replacement can have excellent early and respectable midterm outcomes, even when combined with arch repair. Further follow-up remains necessary to evaluate the long-term durability of VSARR.