The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Pan-Canadian initiative on Fundamental Competencies for Transcatheter Cardiac Surgery: A modified Delphi consensus study.
Transcatheter cardiac procedures have generated increasing interest in trainees and training programs alike. Using the modified Delphi method, we sought to clarify the transcatheter competencies that cardiac surgery residents should be expected to attain by the completion of training. ⋯ The identified fundamental competencies can be used to develop educational strategies during transcatheter cardiac surgery training. Future efforts should focus on collecting evidence for their validity.
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Influence of intraoperative residual lesions and timing of extracorporeal membrane oxygenation on outcomes following first-stage palliation of single-ventricle heart disease.
Data regarding the influence of intraoperative residual lesions on extracorporeal membrane oxygenation (ECMO) following the Norwood procedure are limited. Moreover, the significance of postoperative ECMO timing on in-hospital outcomes remains incompletely characterized. ⋯ The presence of even minor intraoperative residua significantly increases the risk of ECMO following the Norwood operation. Among patients receiving ECMO postoperatively, early institution of ECMO is associated with lower mortality and resource utilization.
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support.
There is limited evidence on standardized protocols for optimal neurological monitoring methods in patients receiving extracorporeal membrane oxygenation (ECMO). We previously introduced protocolized noninvasive multimodal neuromonitoring using serial neurological examinations, electroencephalography, transcranial Doppler ultrasound, and somatosensory evoked potentials. The purpose of this study was to examine if standardized neuromonitoring is associated with detection of acute brain injury (ABI) and improved patient outcomes. ⋯ Standardized neuromonitoring was associated with increased ABIs in ECMO patients. Although neuromonitoring does not prevent ABI from occurring, it might prevent worsening with timely interventions (eg, anticoagulation management, optimizing oxygen delivery and blood pressure), leading to improved neurological outcomes at discharge.
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J. Thorac. Cardiovasc. Surg. · Jun 2023
Impact of cost-awareness education and surgeon-led positive deviance on intraoperative costs of thoracoscopic lobectomy.
Disposable instrument use during video-assisted thoracoscopic lobectomy is a significant driver of cost. The purpose of the study was to measure the effect of increasing surgeon cost awareness via successive "value improvement initiatives" on instrument costs. ⋯ Cost awareness and surgeon engagement activities were associated with sustained cost reduction for video-assisted thoracoscopic lobectomies. Surgeon self-assessment, peer comparison, and positive deviance seminar were associated with the largest cost reduction. Significant hospital cost-savings may be realized with surgeon-led value improvement initiatives.