Cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact on health care and cardiac surgery. We report cardiac surgeons' concerns, perceptions, and responses during the COVID-19 pandemic.

Methods: A detailed survey was sent to recruit participating adult cardiac surgery centers in North America.

Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches.

Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program.

Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning.

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.

Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management.

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.

Surgical Resection of a Giant Coronary Aneurysm.

Coronary aneurysms are quite uncommon, and those qualifying as giant aneurysms are even more so. Currently, no standardized treatment protocol exists. We report the case of a 46-year-old man presenting with clinical signs and symptoms of acute myocardial infarction who was found to have a giant coronary aneurysm.

Right anterior thoracotomy aortic valve replacement is associated with less cost than sternotomy-based approaches: a multi-institution analysis of 'real world' data.

Background: Large institutional analyses demonstrating outcomes of right anterior mini-thoracotomy (RAT) for isolated aortic valve replacement (isoAVR) do not exist. In this study, a group of cardiac surgeons who routinely perform minimally invasive isoAVR analyzed a cross-section of US hospital records in order to analyze outcomes of RAT as compared to sternotomy.

Methods: The Premier database was queried from 2007-2011 for clinical and cost data for patients undergoing isoAVR.

Update on cardiothoracic surgery resident job opportunities.

Background: Concerns regarding ample employment opportunities for graduating cardiothoracic surgery residents may affect perceptions of the field and recruitment into residency programs. We present the results of the Thoracic Surgery Residents Association/Thoracic Surgery Directors Association (TSRA/TSDA) 2008 Resident Survey, and compare them with the 2007 TSRA/TSDA survey and the 2006 interim report of the Society of Thoracic Surgeons Task Force on Job Opportunities.

Methods: In April 2008, the TSRA/TSDA conducted an anonymous survey, linked to the cardiothoracic surgery resident online In-training Exam, with questions germane to resident job seeking and perceptions of the specialty.

Impact of Preoperative 64-Slice CT Scanning on Mini-Maze Atrial Fibrillation Surgery.

Background: : Multidetector computed tomography (MDCT) is emerging as a powerful noninvasive diagnostic tool. The appropriate role of this technique in the preoperative evaluation of cardiovascular disease has yet to be fully defined. Atrial fibrillation is the most common sustained cardiac arrhythmia, and novel minimally invasive surgical techniques have been developed to treat this condition by electrically isolating the pulmonary veins.

Absence of correlation between symptoms and rhythm in "symptomatic" atrial fibrillation.

Background: Symptoms are widely used as a means of assessment and follow-up of patients with atrial fibrillation. This study assessed the correlation between symptoms and cardiac rhythm in patients being evaluated for operative therapy for atrial fibrillation.

Methods: Seven days of preoperative continuous outpatient home electrocardiographic monitoring was performed on 50 patients with symptomatic atrial fibrillation.

Intraoperative epicardial electrophysiologic mapping and isolation of autonomic ganglionic plexi.

Background: Autonomic ganglionic plexi (GPs) have been implicated as triggers in lone atrial fibrillation (AF). The purpose of this study was to describe the technique and results of epicardial electrophysiologic mapping and the early effects of GP isolation.

Methods: Intraoperative epicardial electrophysiologic mapping was performed on 41 consecutive patients during a stand-alone minimally invasive operation for AF.

The influence of prior abdominal operations on conversion and complication rates in laparoscopic colorectal surgery.

Background And Objectives: A history of a prior abdominal operation is common among patients presenting for laparoscopic colorectal surgery, and its impact on conversion and complication rates has been insufficiently studied. This study compares the conversion rates of patients with and without a prior abdominal operation (PAO).

Methods: We analyzed 1000 consecutive laparoscopic colorectal resection cases.

Enoxaparin inhibits fibrin sheath formation and decreases central venous catheter colonization following bacteremic challenge.

Objective: Inhibition of fibrin sheath formation by enoxaparin decreases catheter colonization. Fibrin-binding radioactive tracer and catheter weights quantify fibrin reduction.

Design: Controlled experimental study of central venous line colonization.

Comparing results of residents and attending surgeons to determine whether laparoscopic colectomy is safe.

Background: This study was undertaken to compare the technical success and outcomes of laparoscopic colectomy performed by resident surgeons (RS) and attending surgeons (AS).

Methods: A review of 451 consecutive laparoscopic colectomies performed by 2 surgeons either with or without a general surgery resident. Data reviewed included demographics, diagnoses, operative data, and outcomes.

How do general surgery replacement residents match up with those recruited through the National Resident Matching Program?

Background: Although the scope and patterns of attrition of general surgery residents have been reported, no study has examined the residents who replaced them. The purpose of this study was to assess the quality of replacement residents (RRs).

Methods: A questionnaire asked program directors (PDs) about the prevalence, characteristics, and disposition of RRs in general surgery residency programs from 2001 to 2002.

Acidification of formula with citric acid is equally effective and better tolerated than acidification with hydrochloric acid.

Objective: To determine whether acidification of formula with citric acid is equally protective against bacterial translocation and gut colonization but better tolerated than acidification with hydrochloric acid in neonatal rabbits.

Design: Paired animal model with control.

Setting: Animal laboratory.

Prospective study of the incidence and complications of bacterial contamination of enteral feeding in neonates.

Purpose: The goal of this study was to determine incidence of, and complications resulting from, bacterial contamination of enteral feedings in neonates.

Methods: A prospective study of 50 tube-fed neonates was conducted. Infants were bolus fed via an open gravity drained system; demographic and clinical data were gathered.

Management of typical and atypical intestinal malrotation.

Background: "Atypical Malrotation" has been increasingly diagnosed at the authors' institution.

Methods: The authors reviewed retrospectively 201 consecutive operations for malrotation over 5 years to anatomically classify, and describe results of operation for, atypical malrotation. The ligament of Treitz (LOT) was classified as high if left of midline and above the 12th thoracic vertebra, low if left of midline and below the 12th thoracic vertebra, and typical if absent or right of midline.

Enteral feeding tubes are a reservoir for nosocomial antibiotic-resistant pathogens.

Background: Patients and their surroundings are known reservoirs for nosocomial pathogens. Enteral feeding tubes and formula are not thought of as reservoirs for nosocomial organisms.

Methods: A prospective observation study was conducted comparing methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) cultured from nosocomial infections and MRSA/VRE cultured from enteral feeding tubes used in the same neonatal intensive care unit during the same time period but in different babies.

Fibrin sheath enhances central venous catheter infection.

Objective: To determine whether fibrin-coated central venous catheters have a higher infection rate, and spawn more septic emboli, than uncoated catheters after exposure to bacteremia.

Design: Animal study comparing catheter infection and blood cultures of fibrin-coated and uncoated catheters exposed to bacteremia.

Setting: Animal laboratory.