The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Comparative StudyDefining operative mortality: Impact on outcome reporting.
Death is an important outcome of procedural interventions. The death rate, or mortality rate, is subject to variability by definition. The Society of Thoracic Surgeons Adult Cardiac Surgery Database definition of "operative" mortality originally included all in-hospital deaths and deaths occurring within 30 days of the procedure. In recent versions of the Society of Thoracic Surgeons Adult Cardiac Surgery Database, "in-hospital" has been modified to include "patients transferred to other acute care facilities," and "deaths within 30 days unless clearly unrelated to the procedure" has been changed to "deaths within 30 days regardless of cause." This study addresses the impact of these redefinitions on outcome reporting. ⋯ A significant percentage of procedural deaths occur after transfer or discharge from the index hospital. This is especially evident in the percutaneous coronary intervention group. These findings illustrate the importance of the definition of "operative" mortality and the need to ensure accuracy in the reporting of data to voluntary clinical registries, such as the Society of Thoracic Surgeons Adult Cardiac Surgery Database and National Cardiovascular Data Registry.
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Randomized Controlled Trial Multicenter Study Comparative StudyProsthesis-patient mismatch in high-risk patients with severe aortic stenosis: A randomized trial of a self-expanding prosthesis.
We compared the incidence of prosthesis-patient mismatch (PPM) between transcatheter aortic valve replacement (TAVR) using a self-expanding bioprosthesis and surgical aortic valve replacement (SAVR) in the CoreValve US High Risk Pivotal Trial. We sought to determine the influence of PPM on clinical outcomes. ⋯ In patients with high surgical risk and severe aortic stenosis, severe PPM is more common in patients treated with SAVR than those treated with TAVR. Patients with severe PPM are a greater risk for death and acute kidney injury than patients without severe PPM.
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Mitral valve-in-valve hemodynamic performance: An in vitro study.
The valve-in-valve (VinV) procedure may be used in high-risk patients with failed mitral surgical bioprostheses. The objective of this in vitro study was to assess the hemodynamic function of different VinV configurations. ⋯ This in vitro study shows that VinV within mitral surgical bioprostheses provides satisfactory hemodynamic results in the majority of patients. However, significant mitral stenosis is more likely to occur when the IOD of the surgical bioprosthesis is <22 mm, and particularly when the percentage of oversizing is >20%. Significant paravalvular regurgitation is rare and occurs with larger IODs and lower percentage of oversizing (8%).
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Editorial ReviewThe American Association for Thoracic Surgery Consensus Guidelines: Reasons and purpose.
The time interval for the doubling of medical knowledge continues to decline. Physicians, patients, administrators, government officials, and payors are struggling to keep up to date with the waves of new information and to integrate the knowledge into new patient treatment protocols, processes, and metrics. Guidelines, Consensus Guidelines, and Consensus Statements, moderated by seasoned content experts, offer one method to rapidly distribute new information in a timely manner and also guide minimal standards of treatment of clinical care pathways as they are developed as part of bundled care programs. These proposed Consensus Guidelines advance The American Association for Thoracic Surgery's mission of leading in cardiothoracic health care, education, innovation, and modeling excellence.
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J. Thorac. Cardiovasc. Surg. · Apr 2016
Editorial ReviewThe present day potential role of fractional flow reserve-guided coronary artery bypass graft surgery.
The favorable impact of fractional flow reserve measurements on the decision-making and overall outcomes of percutaneous coronary artery intervention is well established. However, the clinical application of fractional flow reserve in surgical revascularizations is still debated. The purpose of this article is to provide a comprehensive review on the current potential role of fractional flow reserve guidance in coronary artery bypass grafting.