High-quality cardiac surgery through teamwork.

The high-quality cardiothoracic surgery program is primed for mindful effective surgery. The challenge lies in attaining mindful skills and efficiency. Herein is one journey toward high departmental quality over two decades.

Prothrombin Complex Concentrate Reduces Blood Product Utilization in Heart Transplantation.

Background: Current practices for the reversal of warfarin before cardiac surgery include the use of vitamin K and fresh frozen plasma (FFP) to reduce the risk of bleeding. Although the 2010 International Society of Heart and Lung Transplantation guidelines acknowledge the use of prothrombin complex concentrate (PCC), there is no clear consensus on its efficacy. The objective of this study was to assess the efficacy of four-factor (4-F) PCC administration in patients requiring warfarin reversal before heart transplantation by determining blood product utilization perioperatively.

Rapid Discovery of Functional Small Molecule Ligands against Proteomic Targets through Library-Against-Library Screening.

Identifying "druggable" targets and their corresponding therapeutic agents are two fundamental challenges in drug discovery research. The one-bead-one-compound (OBOC) combinatorial library method has been developed to discover peptides or small molecules that bind to a specific target protein or elicit a specific cellular response. The phage display cDNA expression proteome library method has been employed to identify target proteins that interact with specific compounds.

A contemporary analysis of pulmonary hypertension in patients undergoing mitral valve surgery: Is this a risk factor?

Objective: Pulmonary hypertension (PHT) has been considered a risk factor for mortality in cardiac surgery. Among mitral valve surgery (MVS) patients, we sought to determine if severe PHT increases mortality risk and if patients who undergo concomitant tricuspid valve surgery (TVS) incur additional risk.

Methods: Preoperative PHT was assessed in 1571 patients undergoing MVS, from 2004 to 2013.

"Top Gun" competition: motivation and practice narrows the technical skill gap among new cardiothoracic surgery residents.

Background: Adoption of simulation skills training in cardiothoracic (CT) surgery remains a challenge. This study sought to determine whether a "Top Gun" competition would encourage simulator use and improve technical skills among first-year CT residents.

Methods: A coronary anastomosis simulation module with instructional video was sent to 96 first-year CT residents in traditional programs who were then invited to participate in a Top Gun competition.

Practice improves performance on a coronary anastomosis simulator, attending surgeon supervision does not.

Objectives: Enthusiasm for simulation early in cardiothoracic surgery training is growing, yet evidence demonstrating its utility is limited. We examined the effect of supervised and unsupervised training on coronary anastomosis performance in a randomized trial among medical students.

Methods: Forty-five medical students were recruited for this single-blinded, randomized controlled trial using a low-fidelity simulator.

Natural orifice translumenal endoscopic surgery (NOTES(®)): a technical review.

Introduction: The clinical NOTES literature continues to grow. This review quantifies the published human NOTES experience to date, examines instrument use in detail, and compiles available perioperative outcomes data.

Methods: A PubMed search for all articles describing human NOTES cases was performed.