The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Nov 2014
Scoring system to guide decision making for the use of gentamicin-impregnated collagen sponge to prevent deep sternal wound infection.
The effectiveness of the routine retrosternal placement of a gentamicin-impregnated collagen sponge (GICS) implant before sternotomy closure is currently a matter of some controversy. We aimed to develop a scoring system to guide decision making for the use of GICS to prevent deep sternal wound infection. ⋯ The scoring system provides an impartial assessment of the decision-making process for clinicians to establish if GICS implant is effective in reducing the risk for deep sternal wound infection in individual patients undergoing cardiac surgery through full sternotomy.
-
J. Thorac. Cardiovasc. Surg. · Nov 2014
Impact of tricuspid regurgitation after redo valvular surgery on survival in patients with previous mitral valve replacement.
The impact on survival of tricuspid regurgitation (TR) after redo valvular surgery in patients with previous mitral valve replacement (MVR) is unclear. ⋯ Survival in patients with TR of 2+ or higher after redo valvular surgery was poor. The results of this study suggest that it is important to maintain a postoperative TR less than 2+ to improve long-term survival.
-
J. Thorac. Cardiovasc. Surg. · Nov 2014
Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: up to 21 years of clinical and echocardiographic results.
To assess the very long-term clinical and echocardiographic results of the edge-to-edge repair for mitral regurgitation (MR) due to isolated prolapse or flail of the anterior leaflet. ⋯ In patients with MR due to segmental anterior leaflet prolapse, the very long-term results of the edge-to-edge repair combined with annuloplasty were excellent.
-
J. Thorac. Cardiovasc. Surg. · Nov 2014
Analysis of the learning curve for beating heart, totally endoscopic, coronary artery bypass grafting.
Robotic cardiac surgery has been proved safe and feasible in dedicated centers. We systematically analyzed the learning curve issues associated with totally endoscopic coronary artery bypass grafting (TECAB) using a stepwise approach by a single surgeon who had successfully performed >650 cases of various types of robotic cardiac surgery at our single center. ⋯ Modular-based TECAB procedures can be successfully performed; however, each module has a steep learning curve. A stable and well-trained robotic cardiac team and an experienced cardiac surgeon can achieve good, reproducible results after this substantial learning curve.
-
J. Thorac. Cardiovasc. Surg. · Nov 2014
Relationship among surgical volume, repair quality, and perioperative outcomes for repair of mitral insufficiency in a mitral valve reference center.
Although it has been demonstrated that the repair rates and quality of the repair of mitral insufficiency are superior in mitral valve reference centers, it has not been studied whether an advantage exists for perioperative morbidity and mortality. We report 1 surgeon's evolution over 7 years, specifically considering the changes in perioperative morbidity and mortality. ⋯ As the number of mitral valve repairs performed each year by a single surgeon at a single institution increased, morbidity, including postoperative heart function and length of stay, decreased. This was demonstrated to occur in large part from a reduction in the aortic crossclamp times, despite an increase in the complexity of the procedures. This further demonstrates the value of reference centers for mitral valve surgery.