The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Comparative StudyEpicardial pacemaker implantation and follow-up in patients with a single ventricle after the Fontan operation.
There is an increasing incidence of sinus node dysfunction after the Fontan procedure. Inability to maintain atrioventricular synchrony after the Fontan operation has been associated with an adverse late outcome. Although pacing may be helpful as a primary or adjunct modality after the Fontan procedure, the effects of performing a late thoracotomy or sternotomy for epicardial pacemaker implantation are unknown. In addition, little is known about the long-term effectiveness of epicardial leads in patients with single ventricles. The purpose of this study was to compare the hospital course and follow-up of epicardial pacing lead implantation in patients with Fontan physiology and patients with 2-ventricle physiology. ⋯ Epicardial leads can be safely placed in Fontan patients at no additional risk compared to patients with biventricular physiology. Sensing and pacing qualities were relatively constant in both the Fontan and non-Fontan groups over the first 2 years after implantation.
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A successful clinical program within either a single institution or a multi-institution complex requires the recruitment and retention of excellent faculty, a strong residency program, a successful, recognized research program, and leaders with administrative, organizational, and leadership skills.
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J. Thorac. Cardiovasc. Surg. · Apr 2001
Comparative StudyBilateral skeletonized internal thoracic artery grafts in patients with diabetes mellitus.
Increased risk of deep sternal infections has prohibited routine bilateral internal thoracic artery grafting in diabetic patients. The technique for harvesting the skeletonized internal thoracic artery provides the potential to minimize this risk. The purpose of this study was to compare the outcome of bypass grafting with bilateral skeletonized internal thoracic arteries in diabetic and nondiabetic patients. ⋯ Bilateral skeletonized internal thoracic artery grafting is a good surgical revascularization option in diabetic patients. Operative mortality and prevalence of sternal infection are comparable with those of nondiabetic patients. However, the risk of sternal infection in obese diabetic women is high, and for them we advocate the use of a single artery instead of bilateral internal thoracic arteries.
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Leading a division or department of cardiothoracic surgery is both a tremendous honor and a significant responsibility. Key to such a position of leadership are committed, functional, and loyal teams focused on the end points of success, and the ability of the leader to develop a strategic vision and to implement a functional operating system.
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To be successful, academic medical centers must exhibit leadership, a strong foundation in science and education, wide-ranging clinical experience, continuous innovation, exemplary service, and an earned reputation for consistently good results.