Influence of surgical volume on outcomes in low-risk patients undergoing isolated surgical aortic valve replacement.

Background: Intermediate- and high-risk patients undergoing isolated surgical aortic valve replacement have superior outcomes at higher-volume compared with lower-volume hospitals. This study examines the impact of hospital volume on outcomes in low-risk patients undergoing aortic valve replacement.

Methods: Using data from our 29 North Texas hospital collaborative, we examined 2066 low-risk cases (Society of Thoracic Surgeons Predicted Risk of Mortality of ≤3%) undergoing aortic valve replacement surgery between January 1, 2012, and December 31, 2017.

Establishing a Dedicated General Thoracic Surgery Subspecialty Program Improves Lung Cancer Outcomes.

Background: Various factors may influence outcomes after lobectomy for lung cancer. Postgraduate subspecialty training in general thoracic surgery with a focus on minimally invasive surgery (MIS) and thoracic oncology was completed by an established cardiothoracic surgeon on the hospital staff in July 2007, and principles emphasized in that training were incorporated into practice through formation of a subspecialty program. We hypothesized that establishing a dedicated general thoracic surgeon-lead subspecialty program, with focus on MIS and thoracic oncology, would improve short-term and long-term outcomes.

Comparison of Outcomes of Operative Therapy for Acute Type A Aortic Dissections Provided at High-Volume Versus Low-Volume Medical Centers in North Texas.

Immediate surgery is standard therapy for acute type A aortic dissections (TAAD). Because of its low incidence, many smaller cardiac surgery programs do not routinely perform this procedure because it may negatively affect outcomes. Many high-risk, low-volume (LV) surgical procedures are now preferentially performed in reference centers.

Excess short-term mortality in women after isolated coronary artery bypass graft surgery.

Objective: Female sex is considered a risk factor for adverse outcomes following isolated coronary artery bypass graft (CABG) surgery. We assessed the association between sex and short-term mortality following isolated CABG, and estimated the 'excess' deaths occurring in women.

Methods: Short-term mortality was investigated in 13 327 consecutive isolated CABG patients in North Texas between January 2008 and December 2012.

Redo autograft operations after the Ross procedure.

Background: Autograft dilatation after the Ross procedure is the most common cause of late autograft failure. We looked at results after reoperation for autograft dysfunction using autograft sparing and composite root replacement techniques.

Methods: Data were abstracted from our prospectively collected Ross registry for 160 consecutive patients who underwent a Ross procedure by a single surgeon between 1994 and 2008.

Does body mass index affect outcomes for aortic valve replacement surgery for aortic stenosis?

Background: Obesity is a worldwide healthcare concern, and its association with several chronic diseases is well documented. However, the effect obesity may have on the acute care delivery is not well understood, and in cardiac surgery, reports are conflicting. The purpose of this study is to evaluate the effect of obesity in an isolated aortic valve replacement population.

Influence of surgeon volume on outcomes with aortic valve replacement.

Background: A volume-outcome association has been shown for cardiovascular procedures such as coronary artery bypass grafting. The association of a volume-outcome relationship for aortic valve replacement procedures, however, has not been clearly defined. We evaluated the influence of surgeon volume on operative outcomes with isolated aortic valve replacement and aortic valve replacement with concomitant coronary artery bypass grafting.

Preoperative beta-blocker usage: is it really worthy of being a quality indicator?

Background: Since 2007, the use of preoperative β-blockers has been used as a quality standard for patients undergoing coronary artery bypass graft surgery. Recent studies have called into question of the benefit of empiric preoperative β-blocker use.

Methods: Data were extracted from our Society of Thoracic Surgeons certified database for patients undergoing isolated coronary artery bypass graft surgery from 2000 to 2008.

The Ross procedure performed for aortic insufficiency is associated with increased autograft reoperation.

Background: The Ross procedure in infants/children is generally accepted, while in adults it remains controversial. We examined our adult experience for clinical and operative factors that predict autograft reoperation.

Methods: Prospectively collected data of 160 consecutive adults undergoing a Ross procedure by a single surgeon from July 1994 through June 2008 were reviewed.

Aortic valve replacement surgery: comparison of outcomes in matched sternotomy and PORT ACCESS groups.

Background: In the past decade, minimally invasive approaches have been developed for aortic valve surgery. We reviewed our data to determine if the use of the PORT ACCESS technique has improved hospital morbidity and mortality.

Methods: Data were collected on 90 patients who had a replacement of their aortic valve using PORT ACCESS procedures (PORT ACCESS aortic valve replacement [PAVR]).

Mitral valve surgery: comparison of outcomes in matched sternotomy and port access groups.

Background And Aim Of The Study: The 30-day outcomes were compared between matched groups of patients undergoing mitral valve procedures through Port Access (femoral cannulation, percutaneous retrograde cardioplegia and aortic occlusion), and through a sternotomy.

Methods: By using a Society of Thoracic Surgeons (STS)-certified, audited database, a total of 1108 patients was identified who were operated on between January 1996 and November 2008. A total of 608 mitral valve repair (MV-Rpr) patients (including 241 with Port Access procedures) and 500 mitral valve replacement (MVR) patients (including 45 with Port Access procedures) was included.

Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach.

Background: Advances in technology such as epicardial bipolar radiofrequency pulmonary vein isolation, ganglionated plexi identification, and isolation and thoracoscopic left atrial appendage exclusion have enabled less invasive surgical options for management of atrial fibrillation.

Methods: We performed a prospective, nonrandomized study of consecutive patients with symptomatic paroxysmal atrial fibrillation undergoing a video-assisted, minimally invasive surgical ablation procedure. The procedure consisted of bilateral, epicardial pulmonary vein isolation with bipolar radiofrequency, partial autonomic denervation, and selective excision of the left atrial appendage.

Role of a percutaneous ventricular assist device in decision making for a cardiac transplant program.

Background: The role of a percutaneous ventricular assist device (VAD) for left heart support in the management of patients in cardiogenic shock is not well defined.

Methods: All patients who received LV support using the percutaneous TandemHeart (percTH) ventricular support device (Cardiac Assist, Pittsburgh, PA) were retrospectively reviewed. Indications for insertion included bridge to decision (BTD) or "salvage" and bridge to transplant (BTT).

The role of thromboelastography in directing blood product usage in infant open heart surgery.

Objective: : Thromboelastography (TEG) measures the dynamics of clot formation in whole blood and provides data that can guide specific blood component therapy. This study analyzed whether the implementation of TEG affected blood product utilization and overall hemostasis in infants (6 months and younger) undergoing open heart surgery.

Methods: : TEG values measured include R (time to fibrin formation), angle (fibrinogen formation), and MA (platelet function).

Minimally invasive surgical ablation of atrial fibrillation: six-month results.

Background: A minimally invasive surgery for treatment of atrial fibrillation was developed with bilateral pulmonary vein isolation, mapping, and ablation of the ganglionic plexi and excision of the left atrial appendage. A prospective multicenter registry was created to evaluate the outcomes.

Methods: The procedure was performed through bilateral minithoracotomies with video assistance.

Fewer grafts performed in off-pump bypass surgery: patient selection or incomplete revascularization?

Background: Comparisons of off-pump (OPCAB) versus conventional on-pump coronary artery bypass (CCAB) consistently report fewer grafts per patient with OPCAB. Performing fewer grafts than indicated based on angiographic assessment could result in incomplete revascularization. We questioned whether OPCAB influenced surgeons to perform fewer grafts than needed.

Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches.

Background: Both transsternal and video-assisted thoracoscopic surgery (VATS) approaches are used for thymectomy in myasthenia gravis. We compared outcomes of simultaneous experiences in two institutions: one utilizing the transsternal approach exclusively, the other using VATS procedures for all patients. The Myasthenia Gravis Foundation of America guidelines were used to standardize reporting.

High-risk patients referred for transcatheter aortic valve implantation: management and outcomes.

Background: Aortic valve replacement (AVR) is the treatment of choice for critical aortic stenosis. Selected patients have not previously been referred for AVR because of excessive risk of mortality and morbidity with surgery. The option of transcatheter aortic valve implantation (TAVI) has increased referral of this high-risk cohort for therapeutic intervention.

Current clinical outcomes of percutaneous coronary intervention and coronary artery bypass grafting.

Background: Randomized trials have compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). However, results of these trials in select patients may not accurately reflect current clinical practice using drug-eluting stents (DES) and off-pump CABG. We undertook a prospective registry of coronary revascularization by CABG on-pump and off-pump, and PCI with or without DES, to determine clinical outcomes.

Reliability of risk algorithms in predicting early and late operative outcomes in high-risk patients undergoing aortic valve replacement.

Objective: Risk algorithms were used to identify a high-risk population for transcatheter aortic valve implantation instead of standard aortic valve replacement in patients with aortic stenosis. We evaluated the efficacy of these methods for predicting outcomes in high-risk patients undergoing aortic valve replacement.

Methods: Data were collected on 638 patients identified as having isolated aortic valve replacement between January 1, 1998 and December 31, 2006, using The Society of Thoracic Surgeons (STS) database.

Coronary Artery Revascularization (CARE) registry: an observational study of on-pump and off-pump coronary artery revascularization.

Background: The Coronary Artery Revascularization (CARE) study is a multicenter observational registry of coronary revascularization by percutaneous and surgical techniques. As a substudy of this registry, we analyzed the current practice and outcomes of on-pump and off-pump coronary artery bypass graft (CABG) surgery.

Methods: Procedural and outcomes data were prospectively collected for all patients undergoing isolated CABG in eight community-based hospitals in the HCA Hospital System between February 1 and July 31, 2004.

Reduced atrial fibrillation in patients immediately extubated after off-pump coronary artery bypass grafting.

Background: We analyzed data from patients undergoing off-pump isolated coronary artery bypass grafting surgery (OPCABG) to determine if immediate extubation in the operating room affected the incidence of postoperative atrial fibrillation.

Methods: The study group comprised 2,376 consecutive OPCABG patients operated on between January 1, 2000, and December 31, 2004, by 22 surgeons at 18 hospitals. The data were subjected to univariate, multivariate analysis of variance, and logistic analysis.

One-year follow-up after thoracoscopic sympathectomy for hyperhidrosis: outcomes and consequences.

Background: Thoracic sympathectomy is recognized as an effective treatment for patients with severe hyperhidrosis. While good early results have been documented, continuing efficacy and patient satisfaction has not been well-defined. We reviewed our results in patients who were at least one year out from surgery.

The occurrence of postoperative pulmonary homograft stenosis in adult patients undergoing the Ross procedure.

Background And Aim Of The Study: The Ross procedure employs an autologous pulmonary valve to replace the aortic valve, but requires pulmonary homograft replacement. Concerns regarding long-term homograft function may limit the adoption of this technique. Herein, the incidence of, and factors leading to, stenosis of the homograft were examined.

Does coronary artery bypass graft surgery improve survival among patients with end-stage renal disease?

Background: Cardiovascular disease remains the most frequent cause of death for patients with end-stage renal disease. To determine the long-term benefit of surgical revascularization in this high-risk population, we studied our patients with ESRD having coronary artery bypass graft surgery (CABG), comparing the results of off-pump to on-pump revascularization. As a baseline reference group, we used dialysis patients with a diagnosis of coronary artery disease who did not have surgical revascularization or percutaneous coronary interventions.