The Annals of thoracic surgery
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Aberrant subclavian artery is a rare abnormality that often occurs in association with Kommerell's diverticulum. The optimal surgical treatment is exclusion and reconstruction of the dilated diverticulum or aberrant subclavian artery. To accomplish such a radical operation in a single stage, we have introduced total (or partial) arch replacement using deep hypothermic circulatory arrest and the arch-first technique through a bilateral submammary thoracotomy (the clamshell approach). This technique provides excellent exposure of the neck arteries and the entire thoracic aorta.
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Comparative Study
Technical performance scores in congenital cardiac operations: a quality assessment initiative.
Technical performance in congenital cardiac operations and its association with clinical outcomes was previously examined in infants and neonates. The purpose of this study was the development and implementation of a system for measuring technical performance in the majority of congenital cardiac operations to be used as a surgeon's self-assessment tool. ⋯ The development and implementation of a broad technical performance self-assessment system for congenital cardiac operations is possible. Based on this scoring system, the impact of a less than optimal (2 or 3) technical score depends on case risk category, with higher mortality in the higher risk group, and increased resource use for lower risk procedures.
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Comparative Study
Fontan conversion to one and one half ventricle repair.
In patients with a modified Fontan connection, particularly the right atrial to right ventricular connection, the pulmonary ventricle may enlarge with time. ⋯ Fontan conversion to one and one half ventricle repair is feasible in selected patients with a failing Fontan circulation. Operation can be performed with low early mortality. Arrhythmia surgery should be performed routinely. Quality of life is excellent.