The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2024
A Decade of Robotic Beating-Heart Totally Endoscopic Coronary Bypass (TECAB) at a Single Institution: Outcomes with 10-Year Follow-Up.
Robotic beating-heart totally endoscopic coronary bypass (TECAB) is performed using single or bilateral internal thoracic arteries with good results. Despite slow adoption and limited industry support, we have evolved our practice and continue to routinely perform TECAB. We describe our series of 874 patients undergoing robotic beating-heart TECAB with up to 10-year follow-up. ⋯ In this series of 874 patients with up to 10-year follow-up, we show that robotic TECAB can be performed with excellent early and midterm results using an iterative approach, despite significant challenges. Further industry support and wider surgeon adoption are necessary to ensure sustainability of this procedure.
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J. Thorac. Cardiovasc. Surg. · Aug 2024
A Novel Hybrid Prosthesis for Open Repair of Acute DeBakey Type I Dissection with Malperfusion: Early Results from the PERSEVERE Trial.
Outcomes after hemiarch repair for acute DeBakey type I aortic dissection (ADTI) remain unfavorable, with high rates of major adverse events and negative aortic remodeling. The PERSEVERE study evaluates the safety and effectiveness of the AMDS Hybrid prosthesis, a novel bare metal stent, in patients presenting with preoperative malperfusion. ⋯ Early results show significant reductions in major adverse events and distal anastomotic new entry tears, successfully meeting both primary endpoints. The technical success rate was high. AMDS can be used safely in patients with ADTI dissection with malperfusion.
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J. Thorac. Cardiovasc. Surg. · Aug 2024
Aortic diameter remodeling after frozen elephant trunk as a predictor of early outcomes in thoracoabdominal aortic repair.
Patients who underwent previous frozen elephant trunk implantation for Stanford type A aortic dissection remain at risk for secondary intervention due to unsuccessful distal aortic remodeling. We aimed to investigate the impact of distal aortic remodeling on early outcomes in patients who underwent 2-stage thoracoabdominal aortic repair. ⋯ Patients undergoing thoracoabdominal aortic repair with an aortic diameter 60 mm or more at the distal frozen elephant trunk have worse early outcomes. Moreover, an aortic diameter at the distal frozen elephant trunk is a significant risk factor for early death in patients undergoing thoracoabdominal aortic repair.
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J. Thorac. Cardiovasc. Surg. · Aug 2024
American Association for Thoracic Surgery Quality Gateway: A Surgeon Case Study of Its Application in Adult Cardiac Surgery for Quality Assurance.
To demonstrate the application of American Association for Thoracic Surgery Quality Gateway (AQG) outcomes models to a Surgeon Case Study of quality assurance in adult cardiac surgery. ⋯ Using minimal data collection and models developed using advanced machine learning, this case study shows that probabilities can be generated for operative mortality and major morbidity after virtually all adult cardiac operations. It demonstrates the utility of 21st century causal inference (virtual [digital] twin) tools for assessing quality for surgeons asking "how am I doing?," their patients asking "what are my chances?," and the profession asking "how can we get better?"