The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Editorial ReviewSystematic review of outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection.
Available data on outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection are limited. This is a systematic review of outcomes of this approach. ⋯ Combined proximal stent grafting with distal bare stenting for management of aortic dissection appears to be a reasonable approach for type B aortic dissection, clearly improved true-lumen perfusion and diameter although failing to suppress false-lumen patency completely. Contemporary information on this approach is mainly provided by small series with a wide range of results.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Randomized Controlled TrialOptimal technique for the removal of chest tubes after pulmonary resection.
The objective is to determine the optimal manner to remove a chest tube after pulmonary resection. ⋯ Removal of chest tubes at the end of expiration leads to a lower incidence of non-clinically significant pneumothorax than at the end of inspiration. Because of these findings, this study was closed early and was thus underpowered for finding a statistically significant difference in the rare (1%-3%) clinically significant pneumothoraces.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Late functional outcomes after repair of tetralogy of Fallot with atrioventricular septal defect: a double case-match control study.
We sought to elucidate late functional outcomes of the right ventricular outflow tract and atrioventricular valves after repair of tetralogy of Fallot with atrioventricular septal defect. ⋯ Late survival and atrioventricular valve function after repair of tetralogy of Fallot with atrioventricular septal defect were excellent. Pulmonary valve preservation and avoidance of an artificial conduit were associated with greater freedom from right ventricular outflow tract reintervention. In the current era, the surgically modified history of tetralogy of Fallot with atrioventricular septal defect is not significantly different from that of isolated tetralogy of Fallot or isolated atrioventricular septal defect.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Randomized Controlled Trial Comparative StudyTissue-based coronary surgery simulation: medical student deliberate practice can achieve equivalency to senior surgery residents.
The study objective was to assess the impact of dedicated instruction and deliberate practice on fourth-year medical students' proficiency in performing a coronary anastomosis using a porcine heart model, compared with nonsimulator-trained senior general surgery residents. ⋯ Dedicated instruction of fourth-year medical students with deliberate and distributed practice of microvascular techniques using a porcine end-to-side coronary artery anastomosis simulation model results in performance comparable to that of senior general surgery residents. These results suggest that focused tissue simulator training can compress the learning curve to acquire technical proficiency in comparison with real-time training.
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J. Thorac. Cardiovasc. Surg. · Jun 2013
Clinical impact of neurocognitive deficits after cardiac surgery.
Postoperative neurocognitive deficits (POCDs) have been found to occur frequently after cardiac surgery. Although POCDs have received significant attention in the medical literature and public media, the true clinical impact of these deficits on patient outcomes and quality of life (QOL) is not well defined. ⋯ Neurocognitive deficits can be frequently detected on comprehensive neuropsychometric testing after cardiac surgery. However, they are not associated with any clinically important differences in patient outcome or in QOL after surgery.