Use of a serious game simulation to build early childhood staff capacity for reducing unintentional childhood injuries.

Introduction: Unintentional home injuries are common and costly, with over 1.6 million occurring among U.S.

Complete pulmonary recovery after COVID-19 infection requiring extracorporeal membrane oxygenation: A case report.

Severe pulmonary complications associated with COVID-19 infections are a substantial source of morbidity and/or mortality. Extracorporeal membrane oxygenation (ECMO) has been shown to be a potentially useful therapy in the management of severe COVID-19 infection as a means to facilitate pulmonary recovery. Despite growing evidence to demonstrate the utility of ECMO for COVID-19 respiratory failure, little is known regarding the posthospital discharge recovery and functional status of these patients.

Successful COVID-19 rescue therapy by extra-corporeal membrane oxygenation (ECMO) for respiratory failure: a case report.

Background: The value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50 to 82% in early reports from Wuhan, China. We hypothesized that patient outcomes would be improved at our tertiary cardiothoracic surgery referral center with a protocolized team-approach for ECMO treatment of patients with severe COVID-19 disease.

Case Presentation: A 51-year-old healthy female developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bilateral pneumonia while vacationing in Colorado with her family.

Isolation protocol for a COVID-2019 patient requiring emergent surgical intervention: case presentation.

Background: The concerns of the highly contagious and morbid nature of Coronavirus Disease-2019 (COVID-2019) have prompted healthcare workers to implement strict droplet and contact isolation precautions. Unfortunately, some patients who may be or presumptively or confirmed as infected with COVID-2019 may also require emergent surgical procedures. As such, given the high-risk for exposure of many healthcare workers involved the complex requirements for appropriate isolation must be adhered to.

Management of No-Reflow Phenomenon in the Catheterization Laboratory.

At the conclusion of a primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, and after the cardiologist makes certain that there is no residual stenosis following stenting, assessment of coronary flow becomes the top priority. The presence of no-reflow is a serious prognostic sign. No-reflow can result in poor healing of the infarct and adverse left ventricular remodeling, increasing the risk for major adverse cardiac events, including congestive heart failure and death.

Use of human fibrinogen concentrate during proximal aortic reconstruction with deep hypothermic circulatory arrest.

Objective: Human fibrinogen concentrate (HFC) is approved by the Food and Drug Administration for use at 70 mg/kg to treat congenital afibrinogenemia. We sought to determine whether this dose of HFC increases fibrinogen levels in the setting of high-risk bleeding associated with aortic reconstruction and deep hypothermic circulatory arrest (DHCA).

Methods: This was a prospective, pilot, off-label study in which 22 patients undergoing elective proximal aortic reconstruction with DHCA were administered 70 mg/kg HFC upon separation from cardiopulmonary bypass (CPB).

Comparison of aortic annulus size by transesophageal echocardiography and computed tomography angiography with direct surgical measurement.

This study sought to compare the accuracy of 2-dimensional transesophageal echocardiography (TEE) and computed tomography angiography (CTA) for noninvasive aortic annular sizing as required for transcatheter aortic valve implantation (TAVI). Direct intraoperative (OR) sizing is the gold standard for aortic annular measurement in surgical aortic valve replacement. Unlike surgical aortic valve replacement, TAVI requires noninvasive assessment of aortic annular dimensions for determining the size of prosthesis to be implanted and controversy exists regarding the best imaging technique for TAVI sizing.

Adult surgical experience with Loeys-Dietz syndrome.

Background: Loeys-Dietz syndrome (LDS) results from mutations in receptors for the cytokine transforming growth factor-β leading to aggressive aortic pathology sometimes accompanied by specific phenotypic features including bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity. We reviewed our adult surgical experience with LDS in order to validate current recommendations regarding management of this newly described disease.

Methods: All adult (≥ 18 years old) patients with LDS undergoing surgical treatment at a single referral institution from September 1999 to May 2013 were retrospectively reviewed.

The prognostic importance of the number of dissected lymph nodes after induction chemoradiotherapy for esophageal cancer.

Background: Analyses of adequacy of lymph node dissection during resection of esophageal cancer are based on patients who have not undergone induction chemoradiotherapy. We sought to determine the minimum number of dissected lymph nodes necessary to ensure adequate staging after induction chemoradiotherapy.

Methods: A prospectively maintained thoracic surgery database was queried to identify consecutive patients undergoing postinduction esophagectomy from 1996 to 2010.

Pseudoaneurysm formation after medtronic freestyle porcine aortic bioprosthesis implantation: a word of caution.

Background: A growing literature describes aneurysmal deterioration after implantation of the stentless porcine aortic Medtronic Freestyle bioprosthesis (MFB; Medtronic Inc, Minneapolis, MN), with some suggesting inadequate tissue fixation with immune response as a cause. However, disjointed reports make the significance of these findings difficult to interpret. We address this concern by aggregating available data.

Thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection.

Background: Thoracic endovascular aortic repair (TEVAR) for chronic DeBakey IIIb dissection with associated descending aneurysm remains controversial. This study examines long-term results of TEVAR for this disorder including examination of anatomic features associated with TEVAR outcomes.

Methods: Between July 2005 and January 2013, 32 patients underwent TEVAR for chronic (>30 days) DeBakey IIIb dissection involving the descending thoracic aorta at a single institution and constituted the study cohort.

Surgical management of complex rectourethral fistulas in irradiated and nonirradiated patients.

Background: Rectourethral fistulas are an uncommon, yet devastating occurrence after treatment for prostate cancer or trauma, and their surgical management has historically been nonstandardized. Anecdotally, irradiated rectourethral fistulas portend a worse prognosis.

Objective: To review outcomes after surgical treatment of rectourethral fistulas in radiated and nonirradiated patients to construct a logical surgical algorithm.

Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis.

Objective: The choice of cerebral perfusion strategy for aortic arch surgery has been debated, and the superiority of antegrade (ACP) or retrograde (RCP) cerebral perfusion has not been shown. We examined the early and late outcomes for ACP versus RCP in proximal (hemi-) arch replacement using deep hypothermic circulatory arrest (DHCA).

Methods: A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective hemiarch replacement at a single referral institution from June 2005 to February 2013.

Rectourethral fistulas in the cancer survivor.

Purpose Of Review: Iatrogenic rectourethral fistulas (RUFs) are a rare but challenging complication that can follow the treatment of prostate cancer. We review the literature regarding the surgical management of RUFs and subsequent outcomes, focusing on a cause-specific approach.

Recent Findings: Iatrogenic RUFs are reported to occur in approximately 1% of patients treated with external-beam radiation therapy, in 1-6% of patients after radical prostatectomy, and in 5-9% following brachytherapy or cryotherapy after prostate cancer.

Robotic benign esophageal procedures.

Robotic master-slave devices can assist surgeons to perform minimally invasive esophageal operations with approaches that have already been demonstrated using laparoscopy and thoracoscopy. Robotic-assisted surgery for benign esophageal disease is described for the treatment of achalasia, epiphrenic diverticula, refractory reflux, paraesophageal hernias, duplication cysts, and benign esophageal masses, such as leiomyomas. Indications and contraindications for robotic surgery in benign esophageal disease should closely approximate the indications for laparoscopic and thoracoscopic procedures.

Insurance status predicts acuity of thoracic aortic operations.

Objective: Nonelective case status is the strongest predictor of mortality for thoracic aortic operations. We hypothesized that underinsured patients were more likely to require nonelective thoracic aortic surgery because of reduced access to preventative cardiovascular care and elective surgical services.

Methods: Between June 2005 and August 2011, 826 patients were admitted to a single aortic referral center and underwent 1 or more thoracic aortic operations.

Differential prognostic significance of extralobar and intralobar nodal metastases in patients with surgically resected stage II non-small cell lung cancer.

Objectives: We sought to determine the prognostic significance of extralobar nodal metastases versus intralobar nodal metastases in patients with lung cancer and pathologic stage N1 disease.

Methods: A retrospective review of a prospectively maintained lung resection database identified 230 patients with pathologic stage II, N1 non-small cell lung cancer from 1997 to 2011. The surgical pathology reports were reviewed to identify the involved N1 stations.

Outcomes of acute type a dissection repair before and after implementation of a multidisciplinary thoracic aortic surgery program.

Objectives: The purpose of this study was to compare the results of acute type A aortic dissection (ATAAD) repair before and after implementation of a multidisciplinary thoracic aortic surgery program (TASP) at our institution, with dedicated high-volume thoracic aortic surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair.

Background: Outcomes of ATAAD repair may be improved when operations are performed at specialized high-volume thoracic aortic surgical centers.

Methods: Between 1999 and 2011, 128 patients underwent ATAAD repair at our institution.

Comparison of attachment site endoleak rates in Dacron versus native aorta landing zones after thoracic endovascular aortic repair.

Objective: Type I attachment site endoleaks are the most common cause for reintervention after thoracic endovascular aortic repair (TEVAR) and represent treatment failures. Deployment of endografts in segments of the aorta previously replaced with Dacron grafts may be associated with reduced type I endoleak due to mechanical stability and decreased potential for aortic remodeling. However, no study has rigorously examined endoleak rates in Dacron landing zones vs native aorta.

Frailty and risk in proximal aortic surgery.

Objectives: Although frailty has recently been examined in various populations as a predictor of morbidity and mortality, its effect on thoracic aortic surgery outcomes has not been studied. The objective of the present study was to evaluate the role of frailty in predicting postoperative morbidity and mortality in patients undergoing proximal aortic replacement surgery.

Methods: A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective proximal aortic operations (root, ascending aorta, and/or arch) at a single-referral institution from June 2005 to December 2012.

Five-year results for endovascular repair of acute complicated type B aortic dissection.

Introduction: Despite a current lack of U.S. Food and Drug Administration approval for the indication, thoracic endovascular aortic repair (TEVAR) has replaced open surgical management for acute complicated type B aortic dissection due to promising short- and midterm data.

Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open.

Since the introduction of anatomic lung resection by video-assisted thoracoscopic surgery (VATS) was introduced 20 years ago, VATS has experienced major advances in both equipment and technique, introducing a technical challenge in the surgical treatment of both benign and malignant lung disease. The demonstrated safety, decreased morbidity, and equivalent efficacy of this minimally invasive technique has led to the acceptance of VATS as a standard surgical modality for early-stage lung cancer and increasing application to more advanced disease. However, only a minority of lobectomies are performed using the VATS technique, likely owing to concern for intraoperative complications.

Fibrinogen and FXIII dose response effects on albumin-induced coagulopathy.

Objectives: Natural colloid albumin induces a lesser degree of dilutional coagulopathy than synthetic colloids. Fibrinogen concentrate has emerged as a promising strategy to treat coagulopathy, and factor XIII (FXIII) works synergistically with fibrinogen to correct coagulopathy following haemodilution with crystalloids. Our objectives were to examine the ability of fibrinogen and FXIII concentrates to reverse albumin-induced dilutional coagulopathy.

Thoracoabdominal aortic aneurysm: hybrid repair outcomes.

Background: Thoracoabdominal aortic aneurysms (TAAA) remain amongst the most formidable of surgical challenges, particularly degenerative aneurysms in the elderly population with concomitant pulmonary disease. This report presents an update of our robust single-institution experience with "hybrid" TAAA repair including complete visceral debranching and endovascular aneurysm exclusion in high-risk patients.

Methods: Between March 2005 and June 2012, 58 patients underwent extra-anatomic debranching of all visceral vessels followed by aneurysm exclusion via endovascular means at a single institution.