The Annals of thoracic surgery
-
Previous studies suggest center volume is associated with outcome after the Norwood operation; however, the impact of surgeon volume is less clear. We evaluated the relative impact of surgeon and center volume on mortality in a large Norwood cohort. ⋯ Both center and surgeon volumes appear to influence Norwood outcomes. These data suggest outcomes may potentially be improved through strategies that take advantage of the positive influence of both of these variables. This could include further investigation into the feasibility of regional collaborations, and the development of quality improvement initiatives within and across centers.
-
Despite recent studies reporting on the results of prospective intentional sublobar resection for patients with small non-small cell lung cancer (NSCLC), few studies have investigated predictors for prognosis or recurrence exclusively in patients undergoing intentional sublobar resection. ⋯ The factors related to upstaging on pathologic diagnosis were not identified as independent predictors; therefore, the current patient selection criterion seems reasonable. If lymphatic permeation is present on pathologic findings, careful follow-up is recommended. The predictors identified in this study will support assessment and interpretation of the results of ongoing prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLC.
-
Data reported by The Society of Thoracic Surgeons adult cardiac surgery database demonstrate that only 38% of patients with atrial fibrillation (AF) underwent a concomitant surgical ablation. Surgeons are reluctant to add complexity and potential morbidity by including an additional procedure when performing surgery in higher operative risk patients. We investigated perioperative and long-term outcomes in high-risk patients who underwent open heart surgery with or without surgical ablation for AF. ⋯ The addition of an AF surgical ablation procedure did not add operative risk to patients considered high risk, and potentially improved long-term outcome for the subgroup of patients who had their AF ablated. This study suggests that the degree of surgical risk should not be the only decision factor when evaluating this challenging group of patients for surgical ablation.
-
During the past decade, use has increased of moderate hypothermic circulatory arrest with antegrade cerebral perfusion for cerebral protection during aortic arch operations. This study examined the use of mild hypothermia in conjunction with unilateral selective antegrade cerebral perfusion (uSACP) for hemiarch replacement for proximal aortic arch reconstruction. ⋯ Hemiarch replacement can be safely performed at 28°C with uSACP in emergency and elective settings. Mild hypothermia with uSACP offers adequate levels of neurologic protection compared with deeper levels of hypothermia.
-
Case Reports
A video-assisted endotracheal suture technique for correction of distal tracheal laceration after intubation.
The incidence of tracheal laceration is 1 of 20,000 intubations. The most frequently affected area is the posterior tracheal wall (membranous). ⋯ Surgical treatment of tracheal lacerations can be by a transtracheal suture technique or a right thoracotomy. Using the concept of minimally invasive surgical procedures, we reported the treatment of 2 patients with tracheal lacerations greater than 5 cm in the distal trachea that were treated with endotracheal video-assisted suturing using a cervical incision.