The Annals of thoracic surgery
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Comparative Study
Results with selective preoperative lumbar drain placement for thoracic endovascular aortic repair.
The optimal use of lumbar cerebrospinal fluid drainage for the prevention of spinal cord ischemia (SCI) with thoracic endovascular aortic repair (TEVAR) remains unclear. Here, we report our experience with selective preoperative lumbar drain placement with TEVAR. ⋯ Restricted use of preoperative lumbar drains for patients at high-risk of SCI undergoing TEVAR appears safe and leads to low rates of SCI in nondrained patients. However, the utility of preoperative lumbar drains in preventing SCI with TEVAR remains questionable and should be weighed against the risk of drain complications.
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Comparative Study
Heterogeneity of lung volume reduction surgery outcomes in patients selected by use of evidence-based criteria.
Despite its benefit, lung volume reduction surgery (LVRS) is underused, partially because of the heterogeneous responses and lack of recent outcomes data. ⋯ There were durable improvements in FEV1 and exercise capacity in patients meeting the National Emphysema Treatment Trial criteria. Survival was comparable to that in similar patients from the National Emphysema Treatment Trial; response rates were higher in our cohort for FEV1 and 6-MWD. Those with lower 6-MWD, more emphysema, and more hyperinflation at baseline were most likely to respond to LVRS. Those with lowest exercise capacity at baseline may have a higher risk of death after LVRS.
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Comparative Study
Comparison of cardiothoracic training curricula: integrated six-year versus traditional programs.
Traditionally, cardiothoracic residency programs are 2 or 3 years in length and require the completion of a general surgery residency. Six-year integrated programs (IP) that directly match fourth-year medical students have been recently developed. Our objective was to examine the curricula of traditional 2-year (T2) and 3-year (T3) programs and compare them to the curricula of IP. ⋯ Integrated programs should not be considered "cardiac pathways" as they spend a significant amount of time on thoracic rotations. Additional nonsurgical rotations provide an opportunity for residents in IP to develop unique skills not currently provided in traditional programs.
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Management of unbalanced common atrioventricular canal (UCAVC) defect by a single-ventricle (SV) approach frequently results in poor outcomes, especially in trisomy 21 patients. In this report we describe our results with conversion to biventricular circulation in UCAVC patients with SV palliation. ⋯ Biventricular conversion from failing SV palliation in UCAVC can be accomplished with an acceptable early and late morbidity and mortality, although need for reintervention was not uncommon.