The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2024
The Clinical SYNTAX score predicts survival better than the SYNTAX score in coronary revascularization.
The Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) trial showed that the SYNTAX score (SS) is a useful tool for customizing revascularization treatment for patients with multivessel coronary disease. In the past decade, the Clinical SS (CSS) has emerged as a comprehensive tool. This novel tool considers the SS as well as patient clinical parameters such as age, creatinine clearance, and ejection fraction, which were shown to be relevant for patient prognosis. Thus, in the current work we set out to compare the survival predictive values of the SS versus the CSS and their future application in real-world implementation of the revascularization guidelines. ⋯ This prospective registry of real-world revascularization strategies in patients with multivessel disease showed that CSS is a better predictive tool of postrevascularization survival than SS. Moreover, it showed that surgical revascularization in patients with CSS ≥27 is associated with better all-cause mortality outcome after CABG as compared with after PCI. This attests to the need for a score that considers clinical parameters in a real-world scenario.
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J. Thorac. Cardiovasc. Surg. · Jan 2024
Optimal stent length and distal positioning of frozen elephant trunks deployed from the aortic zone 0 for type A acute aortic dissection.
To investigate the optimal stent length and distal positioning of frozen elephant trunks (FETs) in patients with type A acute aortic dissection (TAAD). ⋯ FET positioning with the distal stent end at around Th 8 can reduce residual distal malperfusion when a FET with a 150-mm stent is deployed from the aortic zone 0 in patients with TAAD undergoing total arch repair.
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J. Thorac. Cardiovasc. Surg. · Jan 2024
Total artificial heart implantation as a bridge to transplantation in the United States.
Although the SynCardia total artificial heart (SynCardia Systems, LLC) was approved for use as a bridge to transplantation in 2004 in the United States, most centers do not adopt the total artificial heart as a standard bridging strategy for patients with biventricular failure. This study was designed to characterize the current use and outcomes of patients placed on total artificial heart support. ⋯ Total artificial heart use is low, but the total artificial heart can be an option for biventricular bridge to transplant with acceptable bridge to transplant and post-transplant survival, especially in higher-volume centers. The observation of inferior outcomes in lower-volume centers raises questions as to whether targeted training, center certifications, and minimum volume requirements could improve outcomes for patients requiring the total artificial heart.
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J. Thorac. Cardiovasc. Surg. · Jan 2024
The Journey of Becoming a Congenital Heart Surgeon: Too Long, Too Costly, Too Unpredictable.
The pathway to become a congenital heart surgeon (CHS) is challenging and unpredictable. Previous voluntary manpower surveys have shed partial light on this problem but have not included all trainees. We believe that this arduous journey merits more attention. ⋯ Graduates of CHS fellowships are old, and training is highly variable. Aptitude screening and pediatric-focused preparation are minimal. Debt burden is onerous. Further attention to refining training paradigms and compensation are justified.