The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Impact of Surgical Strategy and Post-Repair Transverse Aortic Arch Size on Late Hypertension After Coarctation Repair During Infancy.
Late hypertension (HTN) after coarctation of the aorta (CoA) repair contributes to higher morbidity and mortality. An association between transverse aortic arch (TAA) hypoplasia and HTN has been found, but its relationship with surgical strategy is unclear. We studied the association between late HTN and initial surgical strategy pertaining to the TAA. ⋯ In patients undergoing surgical repair of CoA during infancy, late HTN was not associated with immediate postrepair TAA size or surgical strategy pertaining to the TAA. These results suggest that factors other than surgical strategy, such as differential growth of the TAA during childhood, may be important.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Five Steps in Performing Machine Learning for Binary Outcomes.
The use of machine learning (ML) in cardiovascular and thoracic surgery is evolving rapidly. Maximizing the capabilities of ML can help improve patient risk stratification and clinical decision making, improve accuracy of predictions, and improve resource utilization in cardiac surgery. The many nuances and intricacies of ML modeling need to be understood to appropriately implement these technologies in the clinical research setting. This primer provides an educational framework of ML for generating predicted probabilities in clinical research and illustrates it with a real-world clinical example. ⋯ Collaboration among surgeons, care providers, statisticians, data scientists, and information technology professionals can help to maximize the impact of ML as a powerful tool in cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Hospital and Surgeon Surgical Valvar Volume and Survival after Multi-Valve Cardiac Surgery in Medicare Beneficiaries.
Long-term outcomes after multivalve cardiac surgery remain underevaluated. ⋯ Survival varied significantly by type of multivalve surgery, worsened with addition of concomitant interventions and improved substantially with increasing annual hospital and surgeon volume. Hospital volume was associated with an improved early hazard for death that abated beyond 3 months post surgery, while surgeon volume was associated with an improved hazard for death that persisted even beyond the first postoperative year. Consideration should be given to referring multivalve cases to high-volume hospitals and surgeons.