Hermanrose5887

The use of continuous-flow mechanical circulatory support in pre-school children remains anecdotal. We describe the sequel to the implantation with a HeartWare™ HVAD™ system in a 3-year old. A 3-year-old male with myocarditis-related cardiomyopathy was implanted with a Heartware device. After an uncomplicated post-operative course, the patient was discharged home. Serial echocardiography showed progressive left ventricle recovery. After 6 months the device was decommissioned and outflow graft tied off. Six years after insertion, it was explanted uneventfully. Heartware Ventricular Assist Device offers a viable long-term mechanical circulatory support in selected children resulting in sustainable care and good quality of life.

Lung cancer remains a major public health problem. There remain differences in mortality among socioeconomic and racial groups. Using the STS GTS database, we attempted to determine whether there were differences in treatment choices by thoracic surgeons based on patient's race or insurance.

Using data from 2012-2017, we analyzed the data from 75,774 patients with a diagnosis of lung cancer who had complete information on race and/or insurance was available and underwent a pulmonary resection. We categorized 66,614 (87.9%) operations into "standard" (lobectomy, bilobectomy, or wedge excision) and 9,160 (12.1%) into complex (pneumonectomy, sleeve or bronchoplastic resection, segmentectomy, or Pancoast resection) operations. Univariate and multiple variable logistic regression models were used to assess associations with receipt of a complex operation.

Patients with private insurance had a higher incidence of complex operations (14.4%) than patients with government insurance (11.6%) (p<0.0001). We also found a higher incidence of complex operations in white patients (12.2%) compared to non-white patients (11.3%) (p=0.0054). On multivariate analysis patients with private insurance were significantly more likely to have a complex operation (odds ratio 1.08, p<0.03) and non-Caucasian patients were less likely to have a complex operation (odds ratio 0.93, p=0.04) respectively.

In this cohort of patients from the STS GTS database, white patients and those with private insurance had a higher incidence of complex operations. Many factors affect the decision to proceed with a complex thoracic surgical operation; type of medical insurance and race may represent two of them.

In this cohort of patients from the STS GTS database, white patients and those with private insurance had a higher incidence of complex operations. Many factors affect the decision to proceed with a complex thoracic surgical operation; type of medical insurance and race may represent two of them.Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) have been popularized as an attractive alternative to redo surgical aortic valve replacement for bioprosthetic valve dysfunction. Acute valve thrombosis has been occasionally described after ViV-TAVR. Lack of anticoagulant therapy has been always considered a crucial risk-factor. We report a rare early post-operative fatal ViV-TAVR thrombosis despite adequate anticoagulation plus dual antiplatelet therapy.We report a case of penetrating aortic ulcer in zone 0 of the ascending aorta with concern for free rupture that was treated by transcarotid endovascular stent graft. The patient was noted to be a poor candidate for open repair given comorbidities, frailty and age. She had a chronic occlusion of the right external iliac artery and stenosis of the left external iliac artery. Endovascular ascending aortic stenting was deployed successfully via right common carotid access. Patient had an uncomplicated postoperative course without evidence of stroke. Transcarotid approach is an optimal alternative access for patients undergoing endovascular ascending aortic repair.

Despite its popularity in recent years, segmentectomy still faces a challenge the accurate delineation of the intersegmental plane (ISP), especially in complex segmentectomy. In this study, we described a method using collateral ventilation to create an inflation-deflation line for video-assisted thoracoscopic surgery (VATS) segmentectomy and evaluated its efficacy in complex segmentectomy by comparing it with simple segmentectomy.

Enrolled in the study were 264 patients who underwent VATS segmentectomy from January 2017 to September 2018. We classified the clarity of the inflation-deflation line into four grades, and the procedures of grade 3 or 4 were considered successful. Meanwhile, a propensity score matching analysis was performed to compare complex and simple segmentectomy.

Complete resection with free margins was achieved in all patients. In inflation-deflation line clarity evaluation, 245 (92.8%) patients were classified as grade 4, 10 (3.8%) as grade 3, 8 (3.0%) as grade 2 and 1(0.4%) as grade 1. Procedural success (grade 3 or 4) was achieved in 255 (96.6%) patients. Prolonged air leak (>5 days) was observed in 11 (4.2%) patients. The propensity matching generated 83 pairs of well-matched patients. The proportion of procedural success and the incidence of prolonged air leak (>5 days) were similar in both groups. https://www.selleckchem.com/products/donafenib-sorafenib-d3.html However, compared with simple segmentectomy, complex segmentectomy was found associated with a longer median operative time (159 min versus 135min, P < 0.001).

Collateral ventilation method is simple, safe, and effective in VATS segmentectomy to identify the ISP and also well adapted for complex segmentectomy.

Collateral ventilation method is simple, safe, and effective in VATS segmentectomy to identify the ISP and also well adapted for complex segmentectomy.Randomized trials in surgery face additional challenges compared to those in medicine. Some of the challenges are intrinsic to the nature of the field (such as issues with blinding, learning curve and surgeons experience and difficulties in defining the appropriate timing for comparative trials). Other issues are due to the surgical culture, the attitude of surgeons toward randomized trials and the lack of support by professional and national bodies. In this review a group with experience in trials in congenital and adult cardiac and thoracic surgery discusses the key issues with surgical trials and suggest potential solutions.