Novel Technique of Surgical Management of Scimitar Syndrome.

Scimitar syndrome is a rare congenital abnormality resulting from right-sided pulmonary venous return to the inferior vena cava rather than to the left atrium. It is usually detected in early childhood with symptoms of recurrent chest infection and finding of pulmonary hypertension due to left to right shunt. We report a case of a 40-year-old woman with scimitar syndrome discovered on chest X-ray during evaluation of recurrent pneumonia.

Thirty-year experience with a bileaflet mechanical valve prosthesis.

Background: The objective was to evaluate the long-term outcomes of the St Jude Medical (Saint Paul, Minn) mechanical valve prosthesis implantation.

Methods: Since 1979, every patient receiving this prosthesis has been followed annually.

Results: From January 1979 to December 2014, 1023 patients were accrued.

Integrated surgical residency initiative: implications for cardiothoracic surgery.

The history, conceptualization, and implementation of the integrated six year cardiothoracic residency paradigm is discussed. Emphasis is placed of critcal logistical points, as well as the challenges associated with obtaining operative case requirements. Strategies for providing and monitoring didactic and technical skills education are presented.

Carolyn Elaine Reed, MD March 4, 1950-November 16, 2012.

Carolyn Reed, 48th President of The Society of Thoracic Surgeons, was an accomplished surgeon, an outstanding educator, a dedicated investigator, a role model for both women and men in surgery, and a national leader in our specialty of cardiothoracic surgery. She filled all of these roles extremely well, but most important to her was her role as a physician who truly cared about her patients, friends, and colleagues as was apparent in her 2007 Southern Thoracic Surgical Association Presidential Address, "Patient Versus Customer, Technology Versus Touch: Where Has Humanism Gone?"

The Joint Council on Thoracic Surgery Education coronary artery assessment tool has high interrater reliability.

Background: Barriers to incorporation of simulation in cardiothoracic surgery training include lack of standardized, validated objective assessment tools. Our aim was to measure interrater reliability and internal consistency reliability of a coronary anastomosis assessment tool created by the Joint Council on Thoracic Surgery Education.

Methods: Ten attending surgeons from different cardiothoracic residency programs evaluated nine video recordings of 5 individuals (1 medical student, 1 resident, 1 fellow, 2 attendings) performing coronary anastomoses on two simulation models, including synthetic graft task station (low fidelity) and porcine explant (high fidelity), as well as in the operative setting.

Evaluation of simulation training in cardiothoracic surgery: the Senior Tour perspective.

Objective: The study objective was to introduce senior surgeons, referred to as members of the "Senior Tour," to simulation-based learning and evaluate ongoing simulation efforts in cardiothoracic surgery.

Methods: Thirteen senior cardiothoracic surgeons participated in a 2½-day Senior Tour Meeting. Of 12 simulators, each participant focused on 6 cardiac (small vessel anastomosis, aortic cannulation, cardiopulmonary bypass, aortic valve replacement, mitral valve repair, and aortic root replacement) or 6 thoracic surgical simulators (hilar dissection, esophageal anastomosis, rigid bronchoscopy, video-assisted thoracoscopic surgery lobectomy, tracheal resection, and sleeve resection).

Administration of recombinant activated factor VII in the intensive care unit after complex cardiovascular surgery: clinical and economic outcomes.

Objective: Refractory bleeding after complex cardiovascular surgery often leads to increased length of stay, cost, morbidity, and mortality. Recombinant activated factor VII administered in the intensive care unit can reduce bleeding, transfusion, and surgical re-exploration. We retrospectively compared factor VII administration in the intensive care unit with reoperation for refractory bleeding after complex cardiovascular surgery.

Combined carotid endarterectomy and coronary artery bypass grafting versus coronary artery bypass grafting alone: a retrospective review of outcomes at our institution.

Background: It remains controversial whether patients with concomitant carotid and coronary disease should undergo operative repair separately or in combination.

Methods: Patients with documented cerebrovascular disease undergoing coronary artery bypass grafting (CABG) alone were matched by propensity scoring with patients undergoing combined carotid endarterectomy (CEA)/CABG procedures and compared for the occurrence of stroke, myocardial infarction (MI), and mortality.

Results: Of the 4943 patients undergoing CABG, 908 had known cerebrovascular disease.

Circulating matrix metalloproteinase levels after ventricular septal defect repair in infants.

Background: Surgery for congenital heart disease initiates a complex inflammatory response that can influence the postoperative course. However, broad integration of the cytokine and proteolytic cascades (matrix metalloproteinases: MMPs), which may contribute to postoperative outcomes, has not been performed.

Methods And Results: Using a low-volume (50-60 μL), high-sensitivity, multiplex approach, we serially measured a panel of cytokines (interleukins 2, 4, 6, 8, and 10, tumor necrosis factor alpha, interleukin 1β, and granulocyte-macrophage colony stimulating factor) and matrix metalloproteinases (matrix metalloproteinases 2, 3, 7, 8, 9, 12, and 13) in patients (n = 9) preoperatively and after repair of ventricular septal defect.

Horace Smithy: pioneer heart surgeon.

Horace Smithy, a native Virginian, received his surgical education in Charleston, then joined the Medical College of South Carolina faculty. He developed a valvulotome, which was used to perform a successful mitral valvulotomy on a 21-year-old woman on January 30, 1948. Smithy himself suffered from rheumatic aortic stenosis and tried unsuccessfully to convince Alfred Blalock to use his valvulotome and operate on him.

Effects of aprotinin or tranexamic acid on proteolytic/cytokine profiles in infants after cardiac surgery.

Background: After cardiopulmonary bypass (CPB), elaboration of cytokines, and subsequent induction of interstitial proteases, such as matrix metalloproteinases (MMPs), can result in a complex postoperative course. The serine protease inhibitor, aprotinin, which has been used in congenital heart surgery putatively for modulating fibrinolysis is now unavailable, necessitating the use of lysine analogues such as tranexamic acid (TXA). The present study tested the hypothesis that distinctly different plasma profiles of signaling molecules and proteases would be differentially affected after the administration of aprotinin or TXA in the context of congenital cardiac surgery and CPB.

Twenty-five year experience with the St. Jude medical mechanical valve prosthesis.

Background: We evaluated all adult St. Jude mechanical valve recipients at our institution since the initial implant in January 1979 and now present our 25-year experience.

Methods: Nine hundred forty-five valve recipients were followed prospectively at 12-month intervals from January 1979 to December 2007.

Endothelin-A receptor inhibition after cardiopulmonary bypass: cytokines and receptor activation.

Background: Basic studies have suggested that cross-talk exists between the endothelin-A receptor (ET-AR) and tumor necrosis factor signaling pathway. This study tested the hypothesis that administration of an ET-AR antagonist at the separation from cardiopulmonary bypass would alter the tumor necrosis factor activation in the early postoperative period.

Methods: Patients (n = 44) were randomly allocated to receive bolus infusion of vehicle, 0.

Use of recombinant activated factor VII concentrate to control postoperative hemorrhage in complex cardiovascular surgery.

Background: Complex cardiovascular surgery often results in postoperative hemorrhage. Excessive blood product use may cause systemic thrombosis, end-organ dysfunction, and edema preventing chest closure. Recombinant activated factor VII (rFVIIa) concentrate may decrease hemorrhage where other treatment measures failed.

Effect of preoperative use of propranolol on postoperative outcome in patients with tetralogy of Fallot.

The aim of this study was to determine if preoperative propranolol therapy has a deleterious effect on postoperative variables in patients with tetralogy of Fallot. Data from 97 patients who underwent complete repair of tetralogy of Fallot were reviewed. The patients were divided into 2 groups: those receiving preoperative propranolol therapy (n = 32) and those not receiving therapy (n = 65).

Selective endothelin-A receptor inhibition after cardiac surgery: a safety and feasibility study.

Background: Increased synthesis and release of the bioactive peptide endothelin has been shown to change hemodynamics and postoperative recovery after cardiac surgery. However, the clinical effects of selective interruption of endothelin signaling have not been studied. Because the endothelin-A (ET-A) receptor subtype is the primary cardiovascular effector for endothelin, this study used the ET-A receptor antagonist sitaxsentan sodium (TBC11251Na) to evaluate: (1) dose-dependent changes in pulmonary artery pressure (PAP) and pulmonary (PVRI) and systemic (SVRI) vascular resistance index in patients undergoing on-pump coronary revascularization; and (2) whether ET-RA administration was associated with increased adverse events.