The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results.
The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce recurrent mitral regurgitation. This study reports the clinical and echocardiographic outcomes of papillary muscle relocation combined with mitral annuloplasty. ⋯ In patients with ischemic mitral regurgitation, papillary muscle relocation plus nonrestrictive mitral annuloplasty promotes a significant reversal in left ventricular remodeling, with a considerable decrease in tenting area and coaptation depth. Our approach is a durable method to reduce the recurrence of mitral insufficiency.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality.
Postoperative readmission affects patient care and healthcare costs. There is a paucity of nationwide data describing the clinical significance of readmission after thoracic operations. The purpose of this study was to evaluate the relationship between postoperative readmission and mortality after lung cancer resection. ⋯ Factors associated with early readmission after lung cancer resection include patient comorbidities, type of operation, and socioeconomic factors. Metrics that only report readmissions to the operative provider miss one-fourth of all cases. Readmitted patients have an increased risk of death and demand maximum attention and optimal care.
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J. Thorac. Cardiovasc. Surg. · Nov 2014
Editorial CommentDefining and improving postoperative care.
Although much is known regarding the importance of postoperative care, the surveillance of patients after 30 days from the surgical procedure can be improved. It must be recognized that mortality between 30 and 90 days exceeds what is commonly considered "operative mortality"—death within 30 days of surgery. ⋯ More importantly, surgeons must develop better models to manage the complications that arise after readmission to prevent mortality in readmitted patients. Finally, current guidelines for oncologic surveillance are an area of controversy, and future studies are needed for better direction of resources.