The Annals of thoracic surgery
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Minimally invasive repair of pectus excavatum is a widely used technique for correction of pectus excavatum. Yet despite the advancement in the surgical techniques, it is still associated with various complications, including bar displacement leading to reoperation. To overcome this problem, we developed the double compression and complete fixation bar (DCCF) system that consists of 2 metal bars that are inserted above and below the sternum and compressed to correct pectus excavatum. ⋯ The DCCF system was applied to surgical correction of pectus excavatum, which led to significant reduction in the operation time and postoperative hospital admission period, as well as reduced minimally invasive repair of pectus excavatum complication and bar displacement rates. Therefore, we recommend the application of the DCCF system to the surgical correction of pectus excavatum.
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We present the case of a fistula between the trachea and the esophagogastric anastomosis in a 58-year-old man after esophagectomy. A Hem-o-Lok clip (Teleflex, Morrisville, NC) used at the time to ligate the azygos vein was discovered by esophagoscopy and bronchoscopy to be eroding into both structures. A covered self-expandable Y-shaped metallic tracheobronchial stent was customized with a three-dimensional printed airway model and inserted in place with endoscopic injection of fibrin glue to the anastomotic site. The stent was withdrawn 64 days after implantation, with complete healing of the fistula.
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Randomized Controlled Trial Multicenter Study Comparative Study
Cost-Effectiveness of Self-Expandable Transcatheter Aortic Valves in Intermediate-Risk Patients.
A recent clinical trial showed that self-expandable transcatheter aortic valve replacement (TAVR) was non-inferior to surgical aortic valve replacement (SAVR). However, the cost-effectiveness of self-expandable TAVR in the intermediate-risk population remains unknown. ⋯ Self-expandable TAVR was found to be cost-effective; however, there was moderate uncertainty, reflecting the non-inferiority nature of the data.
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Meta Analysis Comparative Study
A Systemic Review and Meta-Analysis of Sutureless Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation.
Sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) are increasingly adopted methods to treat high-risk patients with severe aortic valve stenosis. We conducted a systematic review and meta-analysis to compare the clinical outcomes between these two recent methods to treat aortic valve disease. ⋯ Our meta-analysis of observational studies demonstrates that early mortality is lower after SU-AVR than after TAVI in selected patients. The rates of stroke and pacemaker implant are comparable between procedures; however, the incidence of paravalvular leak is higher after TAVI.
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The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. The most recent biannual feedback report to participants includes analysis of data submitted from 125 hospitals, representing nearly all centers performing pediatric and congenital heart operations in the United States and Canada. In addition to serving as a platform for reporting of outcomes and for quality improvement, the database continues to be a primary data source for clinical research and for innovations related to quality measurement. ⋯ Additional ongoing projects involve the development of new or refined metrics for quality measurement and reporting of outcomes and center level performance. To meet the needs of investigators, the STS Research Center and Workforce on Research Development has created multiple pathways through which investigators may propose and, ultimately, perform outcomes research projects based on STS CHSD data. This article reviews published outcomes research and quality improvement projects from the past year and describes ongoing research related to quality measurement.