Linking world bank development indicators and outcomes of congenital heart surgery in low-income and middle-income countries: retrospective analysis of quality improvement data.

Objective: Many low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies.

Design: Retrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment.

Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence.

There are excellent guidelines for clinicians to manage venous diseases but few reviews to assess their hemodynamic background. Hemodynamic concepts that evolved in the past have largely remained unchallenged in recent decades, perhaps due to their often complicated nature and in part due to emergence of new diagnostic techniques. Duplex ultrasound scanning and other imaging techniques which evolved in the latter part of the 20th century have dominated investigation.

Reducing mortality and infections after congenital heart surgery in the developing world.

Background: There is little information about congenital heart surgery outcomes in developing countries. The International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries uses a registry and quality improvement strategies with nongovernmental organization reinforcement to reduce mortality. Registry data were used to evaluate impact.

The relationship between increased body mass index and primary venous disease severity and concomitant deep primary venous reflux.

Background: The role of overweight in chronic venous disease is still controversial. The aim of this study was to evaluate the impact of overweight and obesity in chronic primary venous disease in relation to disease severity, using the CEAP and the Venous Clinical Severity Score (VCSS) as well as well as body weight on the presence of concomitant primary deep venous reflux.

Material: Between October 2005 and September 2010, 1445 consecutive patients (2023 limbs) presenting with duplex ultrasound-confirmed chronic primary venous disease and planned for intervention were evaluated from a database.

Triple valve repair in children with rheumatic heart disease: long-term experience.

Background And Aim Of The Study: Triple valve replacement has poor early and long-term results, particularly in children, and few data are available on triple valve repair. Herein are reported the single-center, long-term results of combined aortic, mitral, and tricuspid valve repair in rheumatic children.

Methods: Ten children (mean age 12 +/- 3 years) with severe rheumatic aortic, mitral, and tricuspid regurgitation underwent triple valve repair over a 17-year period, using a tailored cusp extension to repair the aortic valve, and ring annuloplasty and Carpentier's techniques to repair the mitral and tricuspid valves.

Homografts and xenografts for right ventricular outflow tract reconstruction: long-term results.

Background: Cryopreserved valved homografts are the most commonly used conduit for right ventricular outflow tract reconstruction in children. Early need for reoperation owing to accelerated fibrocalcification has been observed in neonates and children younger than 3 years. A valved bovine jugular vein conduit, Contegra, has shown good early results, without early accelerated fibrocalcification even in the very young patients.

Leaflet suspension to the contralateral annulus to address restriction or tethering-induced mitral and tricuspid regurgitation in children: results of a case-control study.

Objectives: Acceptable coaptation cannot always be obtained using standard repair techniques. We assessed the safety and mid-term results using a novel technique to address leaflet retraction or tethering in children with type III mitral or tricuspid regurgitation as an addition to standard valve repair techniques.

Methods: Forty children were included, 36 for the mitral valve and 4 for the tricuspid valve, with a mean age of 11.

Prospective randomized trial comparing endovenous laser ablation and surgery for treatment of primary great saphenous varicose veins with a 2-year follow-up.

Background: Endovenous laser therapy (EVLT) for ablation of the great saphenous vein (GSV) is thought to minimize postoperative morbidity compared with high ligation and stripping (HL/S). Only a few randomized trials have reported early results. This prospective randomized trial compared EVLT (980 nm) and HL/S results at 1 and 2 years after the intervention.

Aortic valve repair by cusp extension for rheumatic aortic insufficiency in children: Long-term results and impact of extension material.

Objective: Aortic valve repair has encouraging midterm results in selected patients. However, neither the long-term results of cusp extension nor the durability of different pericardial fixation techniques has been reported. Our goal was to address these issues.

A predictive model for identifying surgical patients at risk of methicillin-resistant Staphylococcus aureus carriage on admission.

Background: Legislative mandates and current guidelines for control of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) recommend screening of patients at risk of MRSA carriage on hospital admission. Indiscriminate application of these guidelines can result in a large number of unnecessary screening tests.

Study Design: This study was conducted to develop and validate a prediction model to define surgical patients at risk of previously unknown MRSA carriage on admission.

Mitral valve repair for rheumatic valve disease in children: midterm results and impact of the use of a biodegradable mitral ring.

Background: Mitral valve repair for rheumatic mitral valve disease in children has become the preferred surgical modality. A mitral valve ring is frequently used in the repair. A recently introduced biodegradable ring has shown promising results and allows for growth of the native annulus.

Mitral valve insufficiency: suspension of the posterior leaflet to the mitral annuloplasty ring.

Mitral valve insufficiency in rheumatic heart disease is often due to retracted posterior chordae and posterior leaflet thickening. Several surgical repair techniques have been described, but sometimes an acceptable coaptation of the mitral leaflets can not be achieved. Rather than accept a mitral regurgitation or resort to a mitral valve replacement, particularly in children, we have added a suspension of the posterior leaflet directly to the annuloplasty ring.

Long intraaortic balloon treatment time leads to more vascular complications.

Intraaortic balloon counterpulsation is an established and efficient therapy. Limb ischemia is the most common complication. The impact of treatment duration on balloon-related complications was analyzed retrospectively in 135 patients who underwent balloon counterpulsation between 1998 and 2004.

Postthrombotic or non-postthrombotic severe venous insufficiency: impact of removal of superficial venous reflux with or without subcutaneous fasciotomy.

Background: Severe chronic venous insufficiency is often associated with therapy-resistant or recurrent venous leg ulcers, either as a result of deep vein thrombosis (DVT)- (postthrombotic syndrome [PTS]) or superficial venous insufficiency (SVI). Frequently present dermatoliposclerosis affects the skin as well as the subcutaneous and subfascial structures, which may impact tissue pressures and compromise skin perfusion. This study was undertaken to measure tissue pressures in PTS and SVI limbs and to evaluate the impact of removal of superficial venous reflux with or without concomitant subcutaneous fasciotomy.

Right ventricular outflow tract reconstruction: what conduit to use? Homograft or Contegra?

Background: Both cryopreserved homografts and glutaraldehyde fixed bovine jugular vein grafts (Contegra) are used as conduits for right ventricular outflow tract (RVOT) reconstructions in children. Both types of conduits have their pros and cons vividly described in the literature, but so far only a few comparative studies have been presented.

Methods: Between 1993 and 2005, 88 aortic homografts (54 blood-group compatible, iso, and 34 nonblood-group compatible, non-iso) and 50 Contegra conduits were implanted for RVOT reconstruction.

Long-term outcome after surgical intervention and interventional procedures for the management of Takayasu's arteritis in children.

Objective: There is little information available on the results of reconstructive arterial surgery for Takayasu's arteritis in children. This study evaluates midterm to long-term outcome after surgical, as well as interventional, procedures.

Methods: From 1984 through 2004, 10 children (5 boys and 5 girls; age, 12.

Intra-aortic filtration: capturing particulate emboli during aortic cross-clamping.

Particulate emboli are an important factor in the development of complications after cardiac surgery. The use of an intra-aortic filter during aortic declamping has proved safe and effective in reducing the incidence of embolic complications. Because aortic cross-clamping is also associated with the risk of embolism, we measured the release of particulate emboli at the time of aortic cross-clamping and at declamping.

Changing surgical management for acute aortic dissections type a improves immediate outcomes.

Background: Surgical treatment of acute aortic dissection type A is well established. This study analyzes the impact of changing surgical management of Type A dissections on hospital mortality and postoperative complications.

Method: Between January 1980 and December 2002, 141 consecutive patients were operated for acute Type A aortic dissection.

Bentall procedure using cryopreserved valved aortic homografts: mid- to long-term results.

The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome of Bentall operations with cryopreserved homografts.

In-hospital mortality associated with the use of intra-aortic balloon counterpulsation.

We analyzed in-hospital mortality for patients treated with intra-aortic balloon counterpulsation from the Benchmark Counterpulsation Outcomes Registry (n = 25,136). In-hospital mortality was higher in patients who received only medical interventions (32.5%) than in those who underwent percutaneous (18.