The Annals of thoracic surgery
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Minimally invasive esophagectomy (MIE) is accepted for resection of early esophageal cancers. The optimal surgical approach for more advanced disease is unknown. An evaluation of MIE in patients with advanced tumors having undergone neoadjuvant chemoradiotherapy (nCRT) is presented. ⋯ Minimally invasive esophagectomy is an acceptable surgical therapy for advanced-stage esophageal malignancies after nCRT without evidence for increased morbidity or mortality.
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Although red blood cell (RBC) transfusions are frequently used in cardiac operations, an increasing amount of data has demonstrated deleterious consequences. Consequently, the appropriate use of this limited resource is unclear. In this review, we discuss the relationship between anemia and the outcomes of cardiac surgical procedures, the risks associated with RBC transfusion, and the impact of blood transfusions on mortality and morbidity after cardiac operations. The review concludes with a discussion of randomized trials comparing restrictive versus liberal transfusion strategies and a consideration of blood conservation techniques.
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Venoarterial extracorporeal membrane oxygenation (ECMO) has been used successfully for treatment of cardiogenic shock or cardiac arrest. The exact complication rate is not well understood, in part because of small study sizes. In the absence of large clinical trials, performance of pooled analysis represents the best method for ascertaining complication rates for ECMO. ⋯ Although ECMO can improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention. These findings should be incorporated in the risk-benefit analysis when initiation of ECMO for cardiogenic shock is being considered.
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Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. ⋯ In classifying patients undergoing CHS, APR-DRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality.