The Annals of thoracic surgery
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This study evaluated the role of multidetector computed tomography (MDCT) in preparation for minimally invasive aortic valve replacement (MIAVR). ⋯ Preoperative MDCT of the thorax, aorta, and femoral arteries makes it possible to plan MIAVR operations.
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Delirium is a common complication after cardiac surgical procedures and is associated with increased morbidity and mortality. However, whether rigorously assessed postoperative delirium is associated with an increased length of stay in the intensive care unit (LOS-ICU), length of stay (LOS), and hospital charges is not clear. ⋯ Delirium after cardiac surgical procedures is independently associated with both increased LOS-ICU and higher hospital charges. Because delirium is potentially preventable, targeted delirium-prevention protocols for high-risk patients may represent an important strategy for quality improvement.
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The exact types, frequency, and consequences of early congenital cardiac reoperations are not well known. We aim to describe them and evaluate the potential of early reoperations as a metric for quality of care. ⋯ Early reoperations can be variably related to the index procedure, ranging from repeat of index to repair of associated defects and staged procedures, resulting in different patterns of reoperation types by relationship to the index. Cardiac reoperations within 30 days are associated with increased mortality, which is clustered around a small number of procedures.
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Comparative Study
Surgical Strategy and Outcome for Aortic Root in Patients Undergoing Repair of Acute Type A Aortic Dissection.
This study evaluated the relevance of our indication of aortic root operations for acute type A aortic dissection and compared early and long-term outcomes of emergency type A aortic dissection operations between patients who underwent aortic root operations and those who did not. ⋯ Simultaneous aortic root operations significantly reduced the incidence of late aortic root events. The dissection of 2 or more sinuses of Valsalva was associated with a late aortic root event in patients who did not undergo aortic root operations.
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Extensive literature has proved that the Nuss procedure leads to permanent remodeling of the chest wall in pediatric patients with pectus excavatum (PE). However, limited long-term follow-up data are available for adults. Herein, we report a single-institution experience in the management of adult PE with the Nuss procedure, evaluating long-term outcomes and overall patient satisfaction after bar removal. ⋯ Favorable long-term results can be achieved with the Nuss procedure in adults. However, postoperative pain may require a more aggressive analgesic regimen, and it may be the overriding factor in the patient's perception of the quality of the postoperative course.