Pulmonary Hypertension: A Contraindication for Lung Volume Reduction Surgery?

Background: Historically, pulmonary hypertension (PH) has been considered as one of the contraindications for lung volume reduction surgery (LVRS). Newer studies have shown that LVRS is successful in select emphysema patients with PH.

Methods: In-hospital and 1-year functional and quality of life (QOL) outcomes were studied in patients with PH post-LVRS.

Preoperative heart failure in the Medicare population undergoing mitral valve repair and replacement: an opportunity for improvement.

Background: Elderly patients are under-represented in most surgical series of mitral valve surgery. The impact of preoperative heart failure (HF) on the outcomes of this subset has not been extensively studied.

Methods And Results: The study included 45,082 Medicare beneficiaries who underwent primary isolated mitral valve repair (MVP) (n=16,850) or replacement (MVR) (n=28,232) from 2000 to 2009.

Type A intramural hematoma in the setting of acute type B aortic dissection.

Type A intramural hematoma (IMH) is an uncommon entity, the pathophysiology of which is thought to be related to a contained hemorrhage within the medial layer of the aorta as a result of either rupture of the vasa vasorum or an atherosclerotic plaque. We present a case of type A IMH in the setting of acute type B aortic dissection with suspicion for malperfusion syndrome and discuss the treatment algorithm of this uncommon entity.

Mitral procedure selection in patients on dialysis: does mitral repair influence outcomes?

Objective: To examine the likelihood of mitral valve repair among dialysis patients and the influence of mitral procedure selection on surgical outcomes in this cohort.

Methods: Among patients undergoing isolated primary mitral valve surgery in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2002-2010), we used logistic regression models to evaluate the following: (1) the likelihood of attempted and successful mitral repair among dialysis patients (2008-2010), and (2) the impact of mitral procedural selection on surgical mortality and composite mortality/major morbidity experienced by dialysis patients (2002-2010). Patients with endocarditis and those undergoing emergent or major concomitant surgeries were excluded.

Gender differences in long-term survival of Medicare beneficiaries undergoing mitral valve operations.

Background: Gender disparities in outcomes have been documented in cardiac surgery. Gender differences in long-term survival after mitral valve operations, especially in the elderly, are less well studied.

Methods: Using Centers for Medicare and Medicaid Services data, we identified 183,792 Medicare beneficiaries aged 65 years and older who underwent mitral valve repair or replacement from 2000 through 2009.

Relationship between patient income level and mitral valve repair utilization.

Background: The superiority of mitral valve (MV) repair is well established with respect to long-term survival, preservation of ventricular function, and valve-related complications. The relationship between patient income level and the selection of MV procedure (repair versus replacement) has not been studied.

Methods: The 2005 to 2007 Nationwide Inpatient Sample database was searched for patients ≥ 30 years old with MV repair or replacement; patients with ischemic and congenital MV disease were excluded.

Mitral valve procedure selection and outcomes in patients with rheumatoid arthritis.

Background And Aim Of The Study: Cardiovascular disease is a frequent cause of death in patients with rheumatoid arthritis (RA). Valvular involvement is common, most frequently affecting the mitral valve. Whether RA is an additional risk factor for patients undergoing mitral surgery has not been studied.

Long-term survival of patients undergoing mitral valve repair and replacement: a longitudinal analysis of Medicare fee-for-service beneficiaries.

Background: Despite the established superiority of mitral repair over replacement, its adoption in the treatment of elderly patients has not been uniform, partly because of a lack of robust long-term survival data. We present the long-term survival of Medicare fee-for-service beneficiaries undergoing mitral valve repair and replacement over a 10-year period.

Methods And Results: We used the Medicare database to identify 47 279 fee-for-service beneficiaries ≥65 years of age undergoing primary isolated mitral valve repair or replacement from 2000 to 2009.

Cost analysis of isolated mitral valve surgery in the United States.

Background: Within the field of cardiac surgery, several strategies have been adopted in an effort to address contributors to increasing health care costs. Limited data are available on cost analysis within the field of mitral valve surgery. The purpose of our investigation was to analyze cost differences between mitral valve repair and replacement.

Geographic variation in procedure selection and hospital mortality in mitral valve surgery.

Background And Aim Of The Study: There is paucity of data relating to the geographic variation in mitral valve (MV) repair trends and outcomes of patients undergoing MV surgery.

Methods: Using the 2005-2008 Nationwide Inpatient Sample (NIS) Database, the four geographic regions of the US (Northeast, Midwest, South, and West) were compared with respect to baseline characteristics, mitral procedure selection, and hospital mortality of patients undergoing either MV repair (ICD-9CM code 35.12) or replacement (ICD-9-CM codes 35.

Impact of hospital annual mitral procedural volume on mitral valve repair rates and mortality.

Background And Aim Of The Study: The aim of this investigation was to examine the impact of hospital annual mitral volume on mitral valve (MV) repair rates and mortality.

Methods: The 2005-2008 Nationwide Inpatient Sample (NIS) database was searched to identify patients who had undergone either MV repair (ICD-9-CM code 35.12) or MV replacement (ICD-9-CM codes 35.

Influence of systemic lupus erythematosus on procedure selection and outcomes of patients undergoing isolated mitral valve surgery.

Background: Cardiovascular disease is the main cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). SLE as a risk factor for adverse outcomes during mitral surgery has not been studied. The purpose of this investigation was to compare procedure selection and outcomes of patients with and without SLE.

Mitral valve repair is underused in patients with hypertrophic obstructive cardiomyopathy.

Background: The optimal surgical approach for patients with hypertrophic obstructive cardiomyopathy (HOCM) with concomitant mitral valve (MV) regurgitation has remained controversial. The purpose of this study was to use the largest all-payer database in the United States to examine the strategy most commonly used for the correction of mitral valve pathology in the setting of HOCM.

Methods: The Nationwide Inpatient Sample (NIS) database was searched from 2005 to 2008 to identify patients with a diagnosis of HOCM (ICD-9-CM code 425.

Sex differences in procedure selection and outcomes of patients undergoing mitral valve surgery.

Background: There is a paucity of data on sex differences in procedure selection and outcomes of patients undergoing mitral valve surgery.

Methods And Results: The National Inpatient Sample database from 2005 to 2008 was searched to identify patients ≥30 years of age who underwent mitral valve repair or replacement (ICD-9-CM codes 35.12, 35.

Morgagni hernia presenting as a right middle lobe compression.

A 25-year-old woman with a history of chronic bronchitis since age 12 and 3-4 previous episodes of pneumonia presented to the emergency room with cough and shortness of breath. A CT scan of her chest revealed findings consistent with Morgagni hernia with herniation of omental fat, causing near complete compressive atelectasis of the right middle lobe. The diaphragmatic defect was successfully treated with a laparoscopic repair.

Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database.

Objectives: The purpose of this study was to examine the trends in tricuspid valve surgery over time.

Methods: We used 10 years (1999-2008) of NIS data to examine the population of patients undergoing tricuspid valve repair or replacement (ICD-9-CM codes 35.14, 35.

Impact of race on mitral procedure selection and short-term outcomes of patients undergoing mitral valve surgery.

Background: Racial disparity with respect to mitral valve (MV) surgery has been documented; however, previous reports have been limited by small numbers, focus on patients undergoing MV replacement only, or comparison of African-American patients to white patients. Using more recent data from the largest all-payer database in the United States, we examined whether type of mitral procedure performed was influenced by race and whether racial differences exist in baseline characteristics and short-term outcomes of patients undergoing mitral repair or replacement for MV disease.

Methods: Using the 2005-2007 National Inpatient Sample (NIS) Database, we identified patients ≥ 30 years of age who underwent MV repair or replacement, excluding ischemic and congenital MV disease.

Sternotomy or bilateral thoracoscopy: pain and postoperative complications after lung-volume reduction surgery.

Objectives: Video-assisted thoracoscopic surgery (VATS) and median sternotomy (MS) are two approaches in lung-volume reduction surgery (LVRS). This study focused on the two surgical approaches with regard to postoperative pain.

Methods: In this prospective, non-randomized study, pain was measured preoperatively and postoperatively using the visual analog scale (VAS) and the brief pain inventory (BPI).

Is chronic obstructive pulmonary disease an independent risk factor for transfusion in coronary artery bypass graft surgery?

Objective: The literature is inconsistent regarding the role of chronic obstructive pulmonary disease (COPD) as a risk factor for blood product transfusion during coronary artery bypass graft (CABG). One reason may be lack of objective criteria to define COPD in previously published reports. We examined the role of COPD as a risk factor for transfusion using a strict definition based on objective pulmonary function test (PFT) data.

Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation.

The optimal surgical strategy for the management of ischemic mitral regurgitation (IMR) is still debated. The purpose of this study was to perform a meta-analysis summarizing the evidence favoring one technique over another (repair vs replacement). A search of the English literature in PubMed was performed using 'ischemic mitral regurgitation' and 'repair or replacement or annuloplasty' in the title/abstract field.

Interest in internet lung cancer support among rural cardiothoracic patients.

Background: The Internet may provide an alternative option for rural lung cancer patients who lack access to on-site cancer support; however, Internet access and use among rural patients is unknown.

Methods: An anonymous waiting-room survey was administered to all outpatient cardiothoracic surgery patients over 3 mo. Survey questions included age, gender, and diagnosis, possession of a home computer and Internet service, estimated Internet use, and use of the Internet for health information.

Long-term results and quality-of-life measures in the management of hyperhidrosis.

Primary focal hyperhidrosis has a significant, negative impact on quality of life, causing impairments in social, physical, leisure, and occupational activities. The outcome of different surgical and medical treatment modalities is best assessed by using a combination of tools. Quantitative tools include gravimetry, evaporimetry, and Minor's starch and iodine test.

The effect of thoracoscopic sympathectomy on quality of life and symptom management of hyperhidrosis.

Background: Success with thoracoscopic sympathectomy (TS) for hyperhidrosis is 93% to 100%. We wished to determine if hyperhidrosis patients who do not undergo TS have decreased quality of life (QOL).

Study Design: Data collection was retrospective, with telephone calls to hyperhidrosis patients who qualified for sympathectomy.

Endobronchial valves for treatment of bronchopleural fistula.

Endobronchial valves have recently emerged as a possible alternative to lung volume reduction surgery to treat incapacitating emphysema. The early experience with placement of these valves has been shown to be safe, with short-term improvements of quality of life in this patient population. We report a case in which these valves were used to treat a patient with a persistent air leak.