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Beyersdorf F. Innovation and disruptive science determine the future of cardiothoracic surgery. Eur J Cardiothorac Surg 2024; 65:ezae022. [PMID: 38243711 DOI: 10.1093/ejcts/ezae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 01/21/2024] Open
Abstract
One of the currently most asked questions in the field of medicine is how any specialty in the future will evolve to ensure better health for the patients by using current, unparalleled developments in all areas of science. This article will give an overview of new and evolving strategies for cardiothoracic (CT) surgery that are available today and will become available in the future in order to achieve this goal. In the founding era of CT surgery in the 1950s and 1960s, there was tremendous excitement about innovation and disruptive science, which eventually resulted in a completely new medical specialty, i.e. CT surgery. Entirely new treatment strategies were introduced for many cardiovascular diseases that had been considered incurable until then. As expected, alternative techniques have evolved in all fields of science during the last few decades, allowing great improvements in diagnostics and treatment in all medical specialties. The future of CT surgery will be determined by an unrestricted and unconditional investment in innovation, disruptive science and our own transformation using current achievements from many other fields. From the multitude of current and future possibilities, I will highlight 4 in this review: improvements in our current techniques, bringing CT surgery to low- and middle-income countries, revolutionizing the perioperative period and treating as yet untreatable diseases. These developments will allow us a continuation of the previously unheard-of treatment possibilities provided by ingenious innovations based on the fundamentals of CT surgery.
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Affiliation(s)
- Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
- Medical Faculty of the Albert-Ludwigs-University Freiburg, Germany
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2
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Brescia AA. The second annual Thoracic Surgery Residents Association presidential address: Enter the arena. J Thorac Cardiovasc Surg 2021; 163:189-191. [PMID: 34217532 DOI: 10.1016/j.jtcvs.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/20/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022]
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3
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Abstract
In regional chemotherapy of the pleural space a differentiation is made between intrapleural hyperthermic perfusion (IHP) and hyperthermic intrathoracic chemotherapy (HITOC). The HITOC in particular is carried out as an additive procedure after surgical cytoreduction of the pleural tumor manifestation. The main indications are for malignant pleural mesothelioma and thymoma with pleural spread (stage IVa), whereas treatment of secondary pleural carcinomatosis is indicated only in selected patients suitable for resection followed by HITOC. Cisplatin is the standard chemotherapeutic agent and a concentration of 150-175 mg/m2 body surface area is recommended. Postoperative, HITOC-related complications (e.g. renal insufficiency) can be minimized by an adapted perioperative management. Safety measures should be accomplished adhered to for the protection of personnel. The aim of HITOC is to achieve a better local tumor control with a corresponding longer recurrence-free and overall survival.
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Affiliation(s)
- H-S Hofmann
- Klinik für Thoraxchirurgie, Krankenhaus Barmherzige Brüder Regensburg, Prüfeningerstraße 86, 93049, Regensburg, Deutschland.
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland.
| | - M Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland
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4
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the strengths and weaknesses of systematic reviews and meta-analyses to inform our current understanding of cardiac surgery. RECENT FINDINGS A systematic review and meta-analysis of a focused topic can provide a quantitative estimate for the effect of a treatment intervention or exposure. In cardiac surgery, observational studies and small, single-center prospective trials provide most of the clinical outcomes that form the evidence base for patient management and guideline recommendations. As such, meta-analyses can be particularly valuable in synthesizing the literature for a particular focused surgical question. Since the year 2000, there are over 800 meta-analysis-related publications in our field. There are some limitations to this technique, including clinical, methodological and statistical heterogeneity, among other challenges. Despite these caveats, results of meta-analyses have been useful in forming treatment recommendations or in providing guidance in the design of future clinical trials. SUMMARY There is a growing number of meta-analyses in the field of cardiac surgery. Knowledge translation via meta-analyses will continue to guide and inform cardiac surgical practice and our practice guidelines.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, St Michael's Hospital
| | - Andrea C Tricco
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Blackmon SH, Cooke DT, Whyte R, Miller D, Cerfolio R, Farjah F, Rocco G, Blum M, Hazelrigg S, Howington J, Low D, Swanson S, Fann JI, Ikonomidis JS, Wright C, Grondin SC. The Society of Thoracic Surgeons Expert Consensus Statement: A Tool Kit to Assist Thoracic Surgeons Seeking Privileging to Use New Technology and Perform Advanced Procedures in General Thoracic Surgery. Ann Thorac Surg 2016; 101:1230-7. [PMID: 27124326 DOI: 10.1016/j.athoracsur.2016.01.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/07/2015] [Accepted: 01/14/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Shanda H Blackmon
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
| | - David T Cooke
- Section of General Thoracic Surgery, University of California, Davis Medical Center, Sacramento, California
| | - Richard Whyte
- Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Daniel Miller
- Division of Thoracic Surgery, WellStar Health System, Marietta, Georgia
| | - Robert Cerfolio
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Farhood Farjah
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| | - Gaetano Rocco
- National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Matthew Blum
- Division of Thoracic Surgery, Memorial Hospital-University of Colorado Health, Colorado Springs, Colorado
| | - Stephen Hazelrigg
- Department of Surgery, Southern Illinois University, Springfield, Illinois
| | - John Howington
- Division of Thoracic Surgery, NorthShore University Health System, Evanston, Illinois
| | - Donald Low
- Esophageal Center of Excellence, Virginia Mason Medical Center, Seattle, Washington
| | - Scott Swanson
- Division of Thoracic Surgery, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - James I Fann
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Cameron Wright
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sean C Grondin
- Division of Thoracic Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
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Jacobs JP, Mayer JE, Mavroudis C, O'Brien SM, Austin EH, Pasquali SK, Hill KD, He X, Overman DM, St Louis JD, Karamlou T, Pizarro C, Hirsch-Romano JC, McDonald D, Han JM, Dokholyan RS, Tchervenkov CI, Lacour-Gayet F, Backer CL, Fraser CD, Tweddell JS, Elliott MJ, Walters H, Jonas RA, Prager RL, Shahian DM, Jacobs ML. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Outcomes and Quality. Ann Thorac Surg 2016; 101:850-62. [PMID: 26897186 DOI: 10.1016/j.athoracsur.2016.01.057] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
Abstract
The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This article summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2011 to December 2014 and documenting overall discharge mortality (interquartile range among programs with more than 9 cases): off-bypass coarctation, 1.0% (0.0% to 0.9%); ventricular septal defect repair, 0.7% (0.0% to 1.1%); tetralogy of Fallot repair, 1.0% (0.0% to 1.7%); complete atrioventricular canal repair, 3.2% (0.0% to 6.5%); arterial switch operation, 2.7% (0.0% to 5.6%); arterial switch operation plus ventricular septal defect, 5.3% (0.0% to 6.7%); Glenn/hemiFontan, 2.1% (0.0% to 3.8%); Fontan operation, 1.4% (0.0% to 2.4%); truncus arteriosus repair, 9.6% (0.0 % to 11.8%); and Norwood procedure, 15.6% (10.0% to 21.4%).
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Affiliation(s)
- Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida.
| | - John E Mayer
- Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
| | - Constantine Mavroudis
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida
| | | | - Erle H Austin
- Kosair Children's Hospital, University of Louisville, Louisville, Kentucky
| | - Sara K Pasquali
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Xia He
- Duke University, Durham, North Carolina
| | - David M Overman
- The Children's Heart Clinic at Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - James D St Louis
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | | | | | | | - Jane M Han
- The Society of Thoracic Surgeons, Chicago, Illinois
| | | | | | | | - Carl L Backer
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Charles D Fraser
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - James S Tweddell
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Martin J Elliott
- The Great Ormond Street Hospital, London, England, United Kingdom
| | - Hal Walters
- Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | | | | | - David M Shahian
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida
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7
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Li H. [Precise thoracic surgery: new era of minimally invasive surgery]. Zhonghua Wai Ke Za Zhi 2015; 53:721-723. [PMID: 26654300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Precise surgery is based on the integrated application of modern science and technology and integrated innovation of surgical technology revolution features. It is built in high-end digital medical bases. The purpose of precise surgery is to achieve accurate lesion resection, minimize injury, improve the quality of life and reduce the risk of surgery. In this paper we forward new concept of precise thoracic surgery. An overview was made on the development of precise surgery with great support of virtual reality technology, augmented reality technology and image acquisition technology. Finally the paper illustrated the prospect of precise of thoracic surgery from the following aspects: preoperative planning, the choice of surgical approach, precise tumor localization, postoperative immediate 3-dimension multi modality imaging evaluation.
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Affiliation(s)
- Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China;
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8
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Gao S, Liu Y, Geng Q, Zhao H, Wang J. [Development brief history of thoracic surgery in China]. Zhonghua Wai Ke Za Zhi 2015; 53:27-32. [PMID: 25876619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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9
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Vyzhigina MA, Parshin VD, Titov VA, Alekseev AV. [Actual respiratory technologies in thoracic surgery: traditional problems and innovative solutions]. Khirurgiia (Mosk) 2015:20-32. [PMID: 26753198 DOI: 10.17116/hirurgia20158220-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The problem of efficient gas exchange maintenance is always actual in anesthetic management of thoracic surgery and determines the selection of appropriate method of anesthesia. The article presents an experience of anesthesia during operations on lungs, trachea, bronchi and mediastinal structures performed from 1963 to 2015. Current concept of safety and efficacy of anesthetic management in thoracic surgery is presented. The role of actual current respiratory technologies and methods of anesthesia per se to maximize the efficiency of gas exchange in all stages of thoracicsurgery is emphasized. Absolute coherence of anesthesiologist and surgeon based on correct interaction is the most important condition of successful surgery. Effectiveness of special respiratory technologies for thoracic surgery associated with one-lung ventilation and prolonged wide dissection of airways is described. The research results and pathophysiological rationale for the use of special respiratory technologies including different variants of differentiated independent lung ventilation especially important for patients with concomitant cardiorespiratory pathology are presented. We reported experience of effective gas exchange maintenance in reconstructive surgery of trachea and main bronchi including traditional mechanical ventilation with "shunt-breath" system, use of jet high-frequency ventilation and relatively new respiratory technology such as flow apnoeic oxygenation.
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Affiliation(s)
- M A Vyzhigina
- acad. B.V. Petrovskiy Russian Scientific Center for Surgery, Moscow; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - V D Parshin
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - V A Titov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - A V Alekseev
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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10
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Fertouk M, Bekerman Z, Kremer R, Adler Z, Bolotin G. [Women pioneers: first female cardiothoracic surgeons in the USA and in Israel]. Harefuah 2014; 153:487-496. [PMID: 25286643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
At the beginning of the 1960's, three female doctors managed to break the glass ceiling and become the first female cardiothoracic surgeons in the USA. Since then, the number of certified female cardiothoracic surgeons has steadily increased. Nevertheless, females stilt only account for a minority of cardiothoracic surgeons in the USA. In Israel, three women have become specialists in cardiothoracic surgery over the last two decades, aLthough these surgeons are working as general thoracic surgery consultants, without any representative females in cardiac surgery.
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11
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Khubulava GG, Ryzhman NN, Ovchinnikov IV, Tyrenko VV, Peleshko AS. [ Modern condition and prospects of development of cardiac surgery in the Armed Forces]. Voen Med Zh 2014; 335:4-8. [PMID: 25051782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Authors consider the problem of delivery cardiac surgical care to contingent of the Defence Ministry. Perspective directions of development of cardiac surgery in the Armed Forces of the Russian Federation are the development of minimally invasive cardio surgery, endovascular development of modern methods of diagnosis and treatment, further development of electrophysiological methods for diagnosis and treatment of disorders of rhythm and conduction, the introduction of various kinds of auxiliary mechanical circulatory support systems in acute and chronic heart failure, development of transplantation in cardiac surgery, improvement of algorithm selection and referral of patients requiring cardiac care by providing primary health care to troop central military medical institutions, creating a single register of cardiac patients as part of the Armed Forces in order to determine the order and place of treatment, etc.
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12
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Wood DE. The future of the Society of Thoracic Surgeons. Ann Thorac Surg 2014; 97:S58-62. [PMID: 24384253 DOI: 10.1016/j.athoracsur.2013.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Douglas E Wood
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
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Triggle N. Future of children's heart surgery services in England remains unclear. Nurs Child Young People 2013; 25:7. [PMID: 23957134 DOI: 10.7748/ncyp2013.07.25.6.7.s9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Grant SB, Dixon JL, Glass NE, Sakran JV. Early surgical subspecialization: a new paradigm? Part I. Bull Am Coll Surg 2013; 98:38-42. [PMID: 24205574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Scott B Grant
- Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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von Segesser LK. EACTS Presidential Address: the contraindications of today are the indications of tomorrow. Eur J Cardiothorac Surg 2013; 43:665-72. [PMID: 23509340 DOI: 10.1093/ejcts/ezt049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Lazar H. A message from the editor. J Card Surg 2013; 28:1-2. [PMID: 23330578 DOI: 10.1111/jocs.12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Poullis M. Letter by Poullis regarding article, "Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study)". Circulation 2012; 126:e258. [PMID: 23071181 DOI: 10.1161/circulationaha.112.108928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Banning AP. The view from the interventionalist. Eur J Cardiothorac Surg 2012; 43:250-1. [PMID: 23148071 DOI: 10.1093/ejcts/ezs420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The development of percutaneous valve replacement has broadened the procedural interface between interventional cardiologists and their cardiothoracic surgical colleagues. Our relationship is no longer restricted to the arena of coronary artery disease, and opportunities now exist to share the care of large numbers of high surgical risk patients with severe aortic stenosis. These complex professional relationships have a mutual dependence and many shared objectives that should be centred upon the optimal care of cardiac patients. However, the continuing evolution of technology demands that these relationships evolve with time. A failure to understand this need for mutual change and increased cooperation has previously led to a sense of competition and Departmental separation between cardiac intervention and surgery. These fractured relationships ultimately limit the quality of care that we deliver to our patients.
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Joint annual meeting of the Swiss Society of Pneumology, Swiss Society of Pediatric Pneumology, Swiss Society for Thoracic Surgery, Swiss Underwater and Hyperbaric Medical Society, Crans-Montana, April 25-27, 2012. Respiration 2012; 83:433-78. [PMID: 22584212 DOI: 10.1159/000337694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Beyersdorf F. A new look for EJCTS, ICVTS and MMCTS: better service for our readers with the support of our new publisher, the Oxford University Press. Eur J Cardiothorac Surg 2012; 41:1. [PMID: 22219495 DOI: 10.1093/ejcts/ezr055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aumiller J. [Cardiology and heart surgery: no longer in competition but together: the future of cardiology lies with the cardiology team]. MMW Fortschr Med 2012; 154:32. [PMID: 22619835 DOI: 10.1007/s15006-012-0234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bokeriia LA. [Cardiology and cardiosurgery--innovative development]. Vestn Ross Akad Med Nauk 2012:4-5. [PMID: 22856157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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24
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Capov I. [Future of thoracic surgery in the Czech Republic]. Rozhl Chir 2011; 90:603. [PMID: 22442868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
Cardiac surgery has been scrutinized and challenged as no other specialty has. That has brought new ideas and structural frameworks but has also brought uncertainty and scepticism.This report identifies the challenges that the specialty is facing, and suggests solutions and strategies for the future.
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Affiliation(s)
- Haralabos Parissis
- Consultant Cardiothoracic Surgeon, Cardiothoracic Department, Royal Victoria Hospital, Belfast, UK
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Ivanovic J, Maziak DE, Gilbert S, Shamji FM, Sundaresan RS, Ramsay T, Seely AJE. Assessing the status of thoracic surgical research and quality improvement programs: a survey of the members of the Canadian Association of Thoracic Surgeons. J Surg Educ 2011; 68:258-265. [PMID: 21708361 DOI: 10.1016/j.jsurg.2011.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/26/2011] [Accepted: 02/09/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Assessing the degree of involvement and participation in thoracic surgical research as well as surgical quality improvement conducted across Canadian institutions is difficult as no common data collection system and no prior studies exist. As a pilot investigation, we designed and conducted a membership survey of the Canadian Association of Thoracic Surgeons (CATS) to evaluate the extent of participation in research and quality improvement processes among thoracic surgeons. DESIGN, SETTING, AND PARTICIPANTS A 45-item needs assessment survey was mailed to all national members of CATS (n = 86) in August 2009. Questions primarily focused on clinical research programs and research activity, research funding, database use and interest, and other methods of quality monitoring. RESULTS The 49 completed surveys represented a 57.0% response rate and 28 institutions across Canada. Research in basic and clinical science is conducted by 17.0% and 80.9% of the respondents, respectively. The annual budget of research funds is most commonly between $5000 and $50,000. A total of 72.0% (n = 18) of institutions do not have a formal surgery quality assessment program and 92.3% (n = 24) do not participate in a national or international thoracic surgery database. Ten institutions (38.6%) have a local thoracic surgery database for quality monitoring. Other systems of monitoring surgical quality include formal morbidity and mortality rounds (69.2%; n = 8 institutions), formal evaluation of surgical wait times (73.1%; n = 19 institutions), and patient satisfaction surveys (71.4%; n = 10 institutions). Overall, 97.8% of surgeons would be willing to share data on morbidity and mortality with other centers, and 73.1% have a high or very high level of interest in participating in a national thoracic surgery quality database. CONCLUSIONS A high level of interest and participation exists in thoracic surgery research. However, more robust quality improvement processes are needed for thoracic surgical oncology services. A national thoracic surgery quality improvement database offers a potential means to improve practice effectiveness, standardize surgical outcomes, and promote thoracic research across Canada.
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Affiliation(s)
- Jelena Ivanovic
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, Canada
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27
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Isetta C. [Editorial: French congress on cardiopulmonary bypass and perfusion]. Ann Fr Anesth Reanim 2011; 30 Suppl 1:S1. [PMID: 21703478 DOI: 10.1016/s0750-7658(11)70001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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28
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Punjabi PP. Challenging the conventional wisdom. Perfusion 2011; 26:77. [PMID: 21427139 DOI: 10.1177/0267659110401797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Kabbani SS. Reflections on a heart surgery career with insights for Western-trained medical specialists in developing countries. Tex Heart Inst J 2011; 38:333-339. [PMID: 21841854 PMCID: PMC3147215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Herein, I describe my experience (spanning 40 years) in helping to develop the specialty of cardiovascular surgery in Syria. Especially in the early years, the challenges were daunting. We initially performed thoracic, vascular, and closed-heart operations while dealing with inadequate facilities, bureaucratic delays, and poorly qualified personnel. After our independent surgical center was established in early 1976, we performed 1 open-heart and 1 closed-heart procedure per day. Open-heart procedures evolved from the few and simple to the multiple and complex, and we solved difficulties as they arose. Today, our cardiac surgical center occupies an entire 6-floor building. We have 12 cardiac surgeons, 10 surgical residents, a formal 6-year surgical residency program, a pediatric cardiac unit, an annual caseload of 1,600, and plans to double our productivity in 2 years. The tribulations of establishing sophisticated surgical programs in a developing country are offset by the variety of clinicopathologic conditions that are encountered, and even more so by the psychological rewards of overcoming adversity and serving a population in need. This account may prove to be insightful for Western-trained physicians who seek to develop specialized medical care in emerging societies.
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Affiliation(s)
- Sami S Kabbani
- Damascus University Cardiovascular Surgical Center, Damascus, Syria.
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30
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Kirgizov IV, Seniakovich VM, Shishkin IA. [High-tech methods in pediatric surgery]. Vestn Ross Akad Med Nauk 2011:44-50. [PMID: 21786605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Scientific and technical progress resulting in the introduction of high technologies in medicine radically changed the concept of surgical treatment of children. It is currently based on low-traumatic and minimally invasive methods for surgical intervention. High-tech surgical interventions implies the availability of modern sophisticated equipment and adequate anesthesiological support with comprehensive intraoperative monitoring all vitally important parameters. In the postoperative period, part of the patients need adequate (sometimes long-term) parenteral feeding with the application of long-term Broviak catheters and Space B-Braun systems. The use of this equipment in our Centre makes possible surgical treatment of children at a qualitatively new (low-traumatic and minimally invasive) level and reduce the duration of surgery by 50% compared with traditional methods.
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31
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Soroka VV, Andreĭchuk KA, Kechaeva EI, Postnov AA, Kagachev PN. [Hybrid operating room: a new horizon in cardiovascular surgery]. Angiol Sosud Khir 2011; 17:93-101. [PMID: 22027527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Creating hybrid operating rooms (OR) is a new stage of the development of present-day cardiovascular surgery, with the need for these operating suites having evolved resulting from rapid implementation of novel techniques of treating cardiovascular diseases, combining elements of «open» and endovascular surgery. Despite widespread interest in this problem, there are virtually no systematized works properly describing the specificity of designing and organization of the hybrid OR's work. The present work was aimed at compiling the literature data and sharing own experience gained in organization of the hybrid OR, designation of indispensable technical and organizational requirements for performing hybrid interventions, studying the basic problems related to designing and building such operating rooms, as well as organization and management of the personnel.
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32
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Beyersdorf F. European Journal of Cardio-thoracic Surgery/Interactive Cardiovascular and Thoracic Surgery--reach out for the next decade! Eur J Cardiothorac Surg 2010; 39:147-8. [PMID: 21177114 DOI: 10.1016/j.ejcts.2010.11.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 11/30/2010] [Accepted: 11/30/2010] [Indexed: 11/15/2022] Open
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Abstract
Cardiology and cardiothoracic surgery are closely related so that collaboration and communication are required to offer optimal therapy for patients. During the last decades many innovations have reduced the borders between cardiology and cardiothoracic surgery. Today, cardiologists may perform coronary interventions with good results that would have previously been the domain of coronary bypass surgery. In addition new valvular interventions have been developed, such as transfemoral or transapical aortic valve implantation and endovascular mitral valve reconstruction. New developments in cardiothoracic surgery have led to less invasive procedures and many surgical procedures can now be performed with minimally invasive techniques and without a cardiopulmonary bypass. To enable optimal therapy for patients, closer collaboration between cardiologists and cardiothoracic surgeons is required setting the stage for individualized therapy in the future.
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Affiliation(s)
- R Bekeredjian
- Abteilung Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinik Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
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34
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Pajaro OE. The future of cardiac surgery. J Thorac Cardiovasc Surg 2010; 140:723-4. [PMID: 20723737 DOI: 10.1016/j.jtcvs.2010.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/11/2010] [Indexed: 11/16/2022]
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35
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Loisance D. [Cardiac surgery in China in 2010]. Bull Acad Natl Med 2010; 194:1105-1114. [PMID: 21513140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In China, cardiac surgery has been developing fast over the past 30 years, but it still cannot meet the huge demand created by the high prevalence of risk factors for cardiovascular disease, such as hypertension, diabetes and smoking, and the high frequency of congenital cardiopathies. In China, cardiac surgery is available in about 600 centers, but fewer than 10 centers account for the bulk of operations. Most of these high-volume centers are located in well-developed eastern cities, but cardiac surgery is growing at an extremely rapid pace in the western provinces too. Private structures are appearing alongside public and military hospitals. Huge efforts are being made to train medical staff and to develop basic and clinical research. The Chinese biomedical industry is also developing rapidly, providing local alternatives to imported products. Large university centers in major eastern cities are assisting the development of less experienced centers. The high cost of cardiac surgery remains an obstacle, but the improving economic situation and the expansion of insurance coverage is rapidly improving patient access to these treatments.
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36
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Molina JAD, Heng BH. Global trends in cardiology and cardiothoracic surgery--an opportunity or a threat? Ann Acad Med Singap 2009; 38:541-545. [PMID: 19565106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Coronary heart disease is currently the leading cause of death globally, and is expected to account for 14.2% of all deaths by 2030. The emergence of novel technologies from cardiothoracic surgery and interventional cardiology are welcome developments in the light of an overwhelming chronic disease burden. However, as these complementary yet often competing disciplines rely on expensive technologies, hastily prepared resource plans threaten to consume a substantial proportion of limited healthcare resources. By describing procedural and professional trends as well as current and emerging technologies, this review aims to provide useful knowledge to help managers make informed decisions for the planning of cardiovascular disease management. Since their inception, developments in both specialties have been very rapid. Owing to differences in patient characteristics, interventions and outcomes, results of studies comparing cardiothoracic surgery and interventional cardiology have been conflicting. Outcomes for both specialties continue to improve through the years. Despite the persistent demand for coronary artery bypass surgery (CABG) as a rescue procedure following percutaneous coronary intervention (PCI), there is a widening gap between the numbers of PCI and CABG. Procedural volumes seem to have affected career choices of physicians. Emerging technologies from both disciplines are eagerly awaited by the medical community. For long-term planning of both disciplines, conventional health technology assessment methods are of limited use due to their rapid developments. In the absence of established prediction tools, planners should tap alternative sources of evidence such as changes in disease epidemiology, procedural volumes, horizon scan reports as well as trends in disease outcomes.
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37
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Makuuchi H. [Board of cardiovascular surgery in Japan: past, present, and future]. Nihon Geka Gakkai Zasshi 2009; 110:133-138. [PMID: 19507528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The Japanese Board of Cardiovascular Surgery (JBCVS) was established in 2003. The criteria for board certification were raised compared with those under the previous system. For the past five years, the JBCVS has continuously made efforts to improve the quality of board-certified surgeons. Their number is expected to decrease considerably due to these reforms. Moreover, from 2010, the JBCVS will limit the number of recognized training hospitals by excluding those with small surgical volume. The work environment for cardiovascular surgeons has remained poor in this country, which will likely be worsened by the future decrease in their number. Therefore, every effort should be made to free them from postoperative care and time-consuming administrative tasks by introducing physician's assistant and medical coordinator systems.
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Affiliation(s)
- Haruo Makuuchi
- Department of Cardiovascular Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
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38
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Turina M. Fifty years of cardiothoracic surgery through the looking glass and what the future holds. J Thorac Cardiovasc Surg 2008; 136:1117-22. [PMID: 19026790 DOI: 10.1016/j.jtcvs.2008.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Accepted: 08/25/2008] [Indexed: 11/19/2022]
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39
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Ourselin S, Peters TM. The eight articles finally selected reflect the range of high-quality research presented at MICCAI 2007. Comput Aided Surg 2008; 13:241-242. [PMID: 18821342 DOI: 10.3109/10929080802445386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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40
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Opotowsky AR, Landzberg MJ, Kimmel SE, Webb GD. Trends in the use of percutaneous closure of patent foramen ovale and atrial septal defect in adults, 1998-2004. JAMA 2008; 299:521-2. [PMID: 18252881 DOI: 10.1001/jama.299.5.521] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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41
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Ruan XM. The progress of perioperative therapy with integrative medicine in the field of cardiac surgery. Chin J Integr Med 2008; 13:251-3. [PMID: 18180887 DOI: 10.1007/s11655-007-0251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Indexed: 11/27/2022]
Affiliation(s)
- Xin-min Ruan
- Heart Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, 510105, China.
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42
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Carlos Mota J. [Our iceberg is melting. Part 2]. Rev Port Cir Cardiotorac Vasc 2008; 15:9. [PMID: 18618044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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43
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Korach A, Rudis E, Anner H, Akopnik I, Landesberg G, Berlatzky Y, Elami A. [Evolution of the surgical repair of thoracoabdominal aortic aneurysm]. Harefuah 2007; 146:829-912. [PMID: 18087825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Thoracoabdominal aortic aneurysm repair requires complex surgery. Clamping of the descending aorta during the operation results in organ malperfusion, ischemia, and in some cases, irreversible end-organ damage and death. Several methods for organ preservation during the operation evolved, resulting in decreased post-operative organ malfunction. Re-attachment of intercostal arteries, cerebrospinal fluid drainage, and temporary bypass of the clamped aorta and selective perfusion of the spinal cord, intestine, liver and kidneys are widely used during the operation. OBJECTIVES To determine the impact of implementation of protective measures on the outcome of thoracoabdominal surgery over a decade. METHODS Between March 1993 and March 2003, 11 patients (age 41-80 years, average 60 years) underwent thoracoabdominal aortic aneurysm repair in our hospital. Different methods for organ preservation were used during the operation. RESULTS The early survival is 91%. One patient suffered from paraplegia and one from mild temporary paraparesis. Two patients died during the follow-up period (at 5 months from pneumonia and at 2 years from aortic arch rupture). CONCLUSIONS Implementation of all adjuncts to protect the organs dependent on aortic perfusion may eliminate the ischemic consequences of aortic clamping.
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Affiliation(s)
- Amit Korach
- Department of Cardiothoracic Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel
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44
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Nataf P. European Society of Cardiology Working Groups. Working Group 25: Cardiovascular surgery. Interview by Joanna Lyford. Circulation 2007; 116:f71-2. [PMID: 17879455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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45
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Nashef SAM. Is cardiac surgery now a geriatric specialty? CRIT CARE RESUSC 2007; 9:248-50. [PMID: 17767450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Like all medical specialties that deal with degenerative disease, cardiac surgery is increasingly being offered to older patients. This is driven by longer life expectancy, an increase in the prevalence of degenerative cardiac lesions, a substantial improvement in cardiac surgical results and competition from interventional cardiology in younger patient groups. Although there is no agreed definition of "geriatric", decision-making and the conduct of surgery and postoperative care in the elderly all require some modification of strategy to ensure the best results. Excellent outcomes can now be achieved (albeit at greater financial cost) in the older population, and these results hold well in the long term. Current trends suggest that both the provision and range of cardiac surgical services for the elderly may increase further. Despite this, there is still evidence of reluctance in considering older patients for cardiac surgery.
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46
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Abstract
At the beginning of the twenty-first century, cardiothoracic surgery is arguably the most successful of all medical specialties. There are effective treatments including transplantation, for almost all cardiac and thoracic diseases that can be performed with low morbidity and mortality. Cardiothoracic surgeons have mastered technical difficulties through innovation, hard work, planning and skill. Yet in the past decade, the primacy of cardiothoracic surgery has been challenged by new technologies. This paper applies business school theories to examine how cardiothoracic surgeons might best respond to such "disruptive technologies". Otherwise well-managed business and industrial enterprises have had difficulty dealing with disruptive technological change because of well-recognized organizational impediments. Cardiothoracic surgeons must understand the characteristics of disruptive technologies and consider organizational changes that will allow the profession to better adapt to them.
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Affiliation(s)
- David J Cohen
- Medical Corps, United States Army (retired), Alamo Cardiothoracic Surgical Associates, PA San Antonio, TX, USA.
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Hernandez AF, Grab JD, Gammie JS, O'Brien SM, Hammill BG, Rogers JG, Camacho MT, Dullum MK, Ferguson TB, Peterson ED. A Decade of Short-Term Outcomes in Post–Cardiac Surgery Ventricular Assist Device Implantation. Circulation 2007; 116:606-12. [PMID: 17646586 DOI: 10.1161/circulationaha.106.666289] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Previous studies showed 75% mortality before hospital discharge in patients with a ventricular assist device (VAD) placed for post–cardiac surgery shock. We examined a large national clinical database to assess trends in the incidence of post–cardiac surgery shock requiring VAD implantation, survival rates, and risk factors for mortality.
Methods and Results—
We identified patients undergoing a VAD procedure after cardiac surgery at US hospitals participating in the Society of Thoracic Surgeons’ National Cardiac Database during the years 1995 to 2004. Baseline characteristics and operative outcomes were analyzed in 2.5-year increments. Logistic regression modeling was performed to provide risk-adjusted operative mortality and morbidity odds ratios. A total of 5735 patients had a VAD placed during the 10-year period (0.3% cardiac surgeries). Overall survival rate to discharge after VAD placement was 54.1%. With the earliest period (January 1995 through June 1997) used as reference, the mortality odds ratio declined to 0.72 (July 1997 through December 1999) and eventually to 0.41 (July 2002 through December 2004;
P
<0.0001). The combined mortality/morbidity odds ratio also declined, to 0.84 and 0.48 over identical periods (
P
<0.0001). Preoperative characteristics associated with increased mortality were urgency of procedure, reoperation, renal failure, myocardial infarction, aortic stenosis, female sex, race, peripheral vascular disease, New York Heart Association class IV, cardiogenic shock, left main coronary stenosis, and valve procedure (c index=0.755).
Conclusions—
After adjustment for clinical characteristics of patients requiring mechanical circulatory support, rates of survival to hospital discharge have improved dramatically. Insertion of a VAD for post–cardiac surgery shock is an important therapeutic intervention that can salvage most of these patients.
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48
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Affiliation(s)
- Richard A Jonas
- Department of Cardiac Surgery, Children's National Heart Institute, Children's National Medical Center, Washington, DC 20010, USA.
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49
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Mayaud C. [What may be the future of the Thoracic Department in Tenon Hospital (Paris)?]. Rev Pneumol Clin 2007; 63:235-6. [PMID: 17675948 DOI: 10.1016/s0761-8417(07)90129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- C Mayaud
- Hôpital Tenon, AP-HP, 4, rue de la Chine, 75970 Paris Cedex 20.
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50
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Juffe A. Spotlight: Alberto Juffe, MD, PhD. Interview by Mark Nicholls. Circulation 2007; 115:f88-9. [PMID: 17489098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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