Boydconnell1848

The COVID-19 pandemic has necessitated that operating room procedures be modified to ensure the safety of staff and patients. Specifically, procedures that have the potential to create aerosolization must be reassessed, given the risk of viral transmission via aerosolization. We present the use of a non-sealed endoscopic vessel harvesting(EVH) approach during coronary surgery that does not necessitate the use of CO2 insufflation and utilizes suction through an ultra low particulate filter, thus mitigating the risk of possible viral transmission via aerosolization or surgical smoke production. This approach is technically feasible and can minimize the risk of viral transmission during EVH.Although the use of robot-assisted thoracoscopic surgery (RATS) is increasing rapidly, it allows only a limited visual field on the head side because the RATS camera port is usually placed in the eighth or ninth intercostal space. Because the visual field on the intrathoracic head side is critical during lung cancer surgery, such as when peeling off the first branches of the pulmonary artery (right truncus superior artery or left upper ventral lobe branch), a poor visual field could be fatal. We therefore devised a new port arrangement, the "Hamamatsu method," which ensures a good visual field.Background Most mediastinal biopsy patients are managed with an overnight inpatient stay and chest drainage. We sought to determine the safety, accuracy, and cost of outpatient thoracoscopic mediastinal biopsy by reviewing operative techniques, peri-operative outcomes, and admission charges for this procedure. Methods This single institution retrospective study reviewed all patients who underwent elective thoracoscopic mediastinal biopsy between 2012 and 2017. Patients were assigned to outpatient or inpatient management preoperatively based on surgeon judgment and preference. The procedures were performed in the supine or lateral decubitus position using ports only. Patients discharged on postoperative day 0 (outpatient) were compared to those discharged on postoperative day 1 or greater (inpatient). Results A total of 46 patients were included. Thirty-one patients were outpatients and 15 were admitted. The outpatient cohort was younger than the inpatient group (48 vs 66 years; P = 0.001). There was no statistically significant difference in other baseline characteristics. The operative time was longer (P = 0.001) and the total charges were higher (P = 0.003) in the inpatient cohort. One patient in each group had a non-diagnostic procedure. One patient in the outpatient group returned to the emergency department for pain but was discharged. There were no complications. Conclusions Outpatient thoracoscopic mediastinal biopsy is a safe and effective procedure that has lower charges compared to inpatient management and should be considered for patients undergoing this procedure.Background Learning curves and skill attrition with aging have been reported to impair outcomes in select surgical subspecialties, but their role in complex cardiac surgery remains unknown. Methods From 1986 to 2019, 2,314 patients underwent reoperative cardiac surgery coronary artery bypass grafting (n=543), valve (n=1,527), or combined coronary bypass grafting and valve (n=244). Thirty-four different surgeons in practice between 1 and 39 years were included. Standardized mortality ratio (SMR, observed-to-expected) was determined for all surgeons in each post-training year of experience. Results Risk-adjusted cumulative sum change-point analysis was used to define five distinct career phases 0-4 years, 5-8 years, 9-17 years, 18-28 years, and 29-39 years. With 5-8 years and 18-28 years of experience, SMR was near unity (0.95 and 1.05, respectively) and lowest with 9-17 years of experience (0.78, p=0.03). In the youngest experience group (0-4 years), observed and expected mortality were both highest, and SMR was elevated at 1.29, which approached statistical significance (p=0.059). In the oldest experience group (29-39 years), expected mortality was low compared to most other groups, but observed mortality increased yielding a significantly elevated SMR at 1.53 (p=0.032). Conclusions Standardized mortality ratios with reoperative cardiac surgery were highest early and late in a surgeon's career and lowest mid-career. As surgeons gain experience, outcomes improve through the first two career decades, then stabilize in the third decade before declining in the fourth decade.AngioVac system (AngioDynamics, Latham, NY) has already proved to be effective and safe in the treatment of thrombotic and endocarditic formations concerning the venous district and the tricuspid valve. We describe an innovative use of the Angio-Vac system to treat a left-sided heart mass. learn more In a high-surgical risk patient, we used a micro-invasive transapical access and a modified ECMO circuit to remove the mass from the mitral bioprosthesis without having to replace it. Further experiences are required to confirm the safety of this technique in high-risk patients.The Rastelli operation is a useful technique for treating the transposition of the great arteries. However, conduit stenosis of the right ventricular outflow tract is a late complication of the procedure. We report a case of a 35-year-old man for whom an arterial switch operation was performed to treat conduit stenosis and improve ventricular arterial alignment 28 years after he underwent a Rastelli operation to treat transposition of the great arteries with a ventricular septal defect. In the eight years that followed the operation, he was asymptomatic and was treated with warfarin.Background Contemporary outcomes of open repair of thoracoabdominal aortic (TAAAs) and descending thoracic aortic aneurysms (DTAs) have not been analyzed in an inclusive meta-analysis. Methods Following a systematic literature search, studies from 2008 to 2018 reporting outcomes of open repair of descending thoracic aortic aneurysms or thoracoabdominal aortic aneurysms were pooled in a single-arm meta-analysis performed using the generic inverse variance method. The primary outcome was operative mortality. Secondary outcomes were late mortality, and postoperative stroke, permanent and temporary spinal cord injury, renal failure, respiratory failure, and myocardial infarction. Results Fifty-four studies with 12,245 patients were included. The pooled operative mortality for open repair was 10.4% (95% confidence interval (CI) 8.3-12.8) 6.6% (95%CI 3.7-11.6) for DTA and 10.5% (95%CI 7.5-14.5) for TAAA. The pooled incidence rate of late mortality was 0.6% (95%CI 0.5-0.8) per person-year. The pooled rates for postoperative outcomes were 4.