The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Association between Technical Performance Scores and neurodevelopmental outcomes after congenital cardiac surgery.
Technical Performance Score (TPS) has been shown to have a strong association with early and late outcomes after congenital cardiac surgery, with greater morbidity and reintervention in children with major residual lesions (TPS class 3). We sought to explore the effect of TPS on the neurodevelopmental outcomes. ⋯ We found that TPS is an independent predictor of neurodevelopmental outcomes after infant heart surgery. Future research should explore whether a structured program of intraoperative recognition and intervention on residual lesions can improve the TPS and neurodevelopmental outcomes.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
A novel approach for the accurate prediction of thoracic surgery workforce requirements in Canada.
To develop a microsimulation model of thoracic surgery workforce supply and demand to forecast future labor requirements. ⋯ At the current rate of training, the incidence of operable lung cancer will increase until 2030 and then plateau and decline. The increase will outstrip the supply of thoracic surgeons, but the decline after 2030 will translate into an excess future supply. Minor increases in the rate of training in response to short-term needs could be problematic in the longer term. Unregulated workforce changes should, therefore, be approached with care.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Perioperative factors associated with in-hospital mortality or retransplantation in pediatric heart transplant recipients.
Despite improved long-term survival after pediatric heart transplantation, perioperative mortality has remained high. We sought to understand the factors associated with perioperative graft loss after pediatric heart transplantation. ⋯ The use of extracorporeal membrane oxygenation (both before and after transplantation), a longer ischemic time, and reoperation were key factors associated with perioperative graft loss, with noncardiac mortality closely related to United Network for Organ Sharing status at heart transplantation. Knowledge of the perioperative risk factors and how they affect graft survival will help guide difficult decisions around eligibility, timing of primary listing, and appropriateness for retransplantation, and potentially affect long-term survival.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Clinical TrialRegression of coronary disease after bypass surgery: Urban myth or common finding?
Coronary artery disease has been viewed as a relentless, progressive disease. We sought to describe the prevalence and distribution of regression of native vessel disease in coronary artery bypass patients and characterize its relationship with bypass grafting. ⋯ Native coronary artery disease regression after coronary artery bypass grafting is common and affected by conduit type, vessel location, and lesion severity. Surgeons must consider these factors when assessing the requirement for bypass grafts in a borderline lesion.
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J. Thorac. Cardiovasc. Surg. · Jul 2014
Outcomes of patients born with single-ventricle physiology and aortic arch obstruction: the 26-year Melbourne experience.
To review the long-term outcomes of patients born with single-ventricle physiology and aortic arch obstruction. ⋯ Patients born with single-ventricle physiology and arch obstruction have a high risk of mortality in the first years of life. Their outcomes seem excellent once they reach Fontan status. It is likely that, in patients with single-ventricle and arch obstruction, strategies to avoid systemic outflow tract obstruction should be implemented in early life, and regular monitoring of blood pressure is warranted.