The Annals of thoracic surgery
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Comparative Study
Rigid Primary Sternal Fixation Reduces Sternal Complications Among Patients at Risk.
The optimal sternal closure technique in patients at elevated risk after cardiac surgery has not been elucidated. ⋯ Primary sternal fixation in patients at risk of sternal complications is associated with decreased sternal infection and/or dehiscence. Primary fixation may expand the use of bilateral internal mammary artery grafting to patient populations at increased risk for sternal complications.
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As the largest congenital and pediatric cardiac surgical clinical data registry in the world, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) serves as a platform for reporting of outcomes and for quality improvement. In addition, it is an important source of data for clinical research and for innovations related to quality measurement. ⋯ The STS, through its Workforce for National Databases and the STS Research Center and Workforce on Research Development provides multiple pathways through which investigators may propose and perform outcomes research projects based on STS CHSD data. This report reviews research published within the past year.
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Comparative Study
Mediastinal Nodal Involvement After Neoadjuvant Chemoradiation for Siewert II/III Adenocarcinoma.
Adenocarcinoma of the gastroesophageal junction (AEG) poses a management challenge, as preoperative prediction of occult mediastinal nodal metastasis is difficult. We sought to identify factors predictive of mediastinal involvement among patients undergoing trimodality therapy. ⋯ Pretreatment proximal tumor extent, rather than Siewert classification, is an independent predictor of mediastinal involvement among AEG II/III patients without clinical evidence of mediastinal metastasis and should be considered during treatment planning.
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Multicenter Study
Association of Overnight Extubation With Outcomes After Cardiac Surgery in the Intensive Care Unit.
The frequency and safety of overnight extubation (OE) after cardiac surgery across intensive care units (ICUs) is unknown. ⋯ OE is prevalent after cardiac surgery. OE is associated with little risk and reduces ICU length of stay for patients who require MV for more than 8 hours.
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Robotic-Assisted Lobectomy for Non-Small Cell Lung Cancer: A Comprehensive Institutional Experience.
It is unclear whether the enhanced dexterity and visualization of the surgical robot lessens morbidity and influences staging or survival. We compared outcomes of robotic-assisted lobectomy (RAL) with thoracoscopic video-assisted lobectomy (VAL) or open lobectomy (OL) of non-small cell lung cancer. ⋯ Robotic-assisted lobectomy was associated with improved nodal harvest and less blood loss as compared with VAL or OL. Length of stay was shorter with RAL as opposed to OL. Unexpectedly, cost was not higher with RAL. The profile of patients who received RAL more closely approximated OL, suggesting RAL may allow typical thoracotomy patients to receive minimally invasive surgery after adequate training and experience.