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3.
J Thorac Cardiovasc Surg ; 166(2): 567-568, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34893331
5.
J Thorac Cardiovasc Surg ; 166(1): 171-178, 2023 07.
Artículo en Inglés | MEDLINE | ID: mdl-35410691

RESUMEN

OBJECTIVE: Founded in 2020, the Thoracic Surgery Medical Student Association is the first national organization dedicated to supporting medical students interested in pursuing cardiothoracic surgery. Our inaugural survey aimed to describe their basic characteristics and needs. METHODS: An Institutional Review Board-approved, nonincentivized, anonymous electronic survey was distributed to any medical students enrolled in Liaison Committee on Medical Education-accredited medical schools through social media such as Twitter, national organizations (Association of Women Surgeons, Thoracic Surgery Resident Association), and medical school cardiothoracic surgery interest groups. Their basic characteristics, attitudes, and preferences regarding cardiothoracic surgery were recorded. RESULTS: Of the 167 students from 117 unique schools who completed the survey, 53% identified as White and 57% identified as female. Stages of training were well distributed: 16% first-year medical students, 33% second-year medical students, 16% third-year medical students, 21% fourth-year medical students, and 14% dual degree/research students. Most participants (57%) did not have (32%) or were not aware of having (25%) a thoracic surgery training program at their home institution. The majority (72%) of students reported not having a cardiothoracic surgery interest group at their home institution. The most desired areas of cardiothoracic were networking (31%) and mentorship (28%). CONCLUSIONS: There is a significant need to directly engage medical students who are interested in cardiothoracic surgery considering limited exposure at home institutions through a lack of cardiothoracic surgery interest groups and cardiothoracic residency programs. The Thoracic Surgery Medical Student Association is poised to address these areas with directed networking by connecting cardiothoracic surgery faculty and residents from other institutions with medical students interested in pursuing cardiothoracic surgery.


Asunto(s)
Internado y Residencia , Estudiantes de Medicina , Cirugía Torácica , Procedimientos Quirúrgicos Torácicos , Humanos , Femenino , Estados Unidos , Cirugía Torácica/educación , Selección de Profesión , Procedimientos Quirúrgicos Torácicos/educación
6.
J Thorac Cardiovasc Surg ; 166(2): 565-566, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35346490
7.
Ann Thorac Surg Short Rep ; 1(1): 168-173, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-36545251

RESUMEN

Background: The Society of Thoracic Surgeons Workforce on Critical Care and the Extracorporeal Life Support Organization sought to identify how the coronavirus disease 2019 (COVID-19) pandemic has changed the practice of venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO) programs across North America. Methods: A 26-question survey covering 6 categories (ECMO initiation, cannulation, management, anticoagulation, triage/protocols, and credentialing) was emailed to 276 North American Extracorporeal Life Support Organization centers. ECMO practices before and during the COVID-19 pandemic were compared. Results: Responses were received from 93 (34%) programs. The percentage of high-volume (>20 cases per year) VV ECMO programs increased during the pandemic from 29% to 41% (P < .001), as did institutions requiring multiple clinicians for determining initiation of ECMO (VV ECMO, 25% to 43% [P = .001]; VA ECMO, 20% to 32% [P = .012]). During the pandemic, more institutions developed their own protocols for resource allocation (23% before to 51%; P < .001), and more programs created sharing arrangements to triage patients and equipment with other centers (31% to 57%; P < .001). Direct thrombin inhibitor use increased for both VA ECMO (13% to 18%; P = .025) and VV ECMO (12% to 24%; P = .005). Although cardiothoracic surgeons remained the primary cannulating proceduralists, VV ECMO cannulations performed by pulmonary and critical care physicians increased (13% to 17%; P = .046). Conclusions: The Society of Thoracic Surgeons/Extracorporeal Life Support Organization collaborative survey indicated that the pandemic has affected ECMO practice. Further research on these ECMO strategies and lessons learned during the COVID-19 pandemic may be useful in future global situations.

8.
J Thorac Cardiovasc Surg ; 164(6): e449-e456, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35999086

RESUMEN

For yet another year, our lives have been dominated by a pandemic. This year in review, we feature an expert panel opinion regarding extracorporeal support in the context of COVID-19, challenging previously held standards. We also feature survey results assessing the impact of the pandemic on cardiac surgical volume. Furthermore, we focus on a single center experience that evaluated the use of pulmonary artery catheters and the comparison of transfusion strategies in the Restrictive and Liberal Transfusion Strategies in Patients With Acute Myocardial Infarction (REALITY) trial. Additionally, we address the impact of acute kidney injury on cardiac surgery and highlight the controversy regarding the choice of fluid resuscitation. We close with an evaluation of dysphagia in cardiac surgery and the impact of prehabilitation to optimize surgical outcomes.


Asunto(s)
COVID-19 , Procedimientos Quirúrgicos Cardíacos , Humanos , Transfusión de Eritrocitos/métodos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Transfusión Sanguínea/métodos , Cuidados Críticos
9.
Ann Thorac Surg ; 114(2): 387-393, 2022 08.
Artículo en Inglés | MEDLINE | ID: mdl-35595089

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic continues to disrupt the provision of cardiac procedural services due to overwhelming interval surges in COVID-19 cases and the associated crisis of cardiac intervention deferment. Despite the availability of widespread testing, highly efficacious vaccines, and intensive public health efforts, the pandemic is entering its third year, where new severe acute respiratory syndrome-coronavirus-2 variants have increased the likelihood that patients scheduled for a cardiac intervention will contract COVID-19 in the perioperative period. The Society of Thoracic Surgeons (STS) Workforce on Critical Care, the STS Workforce on Adult Cardiac and Vascular Surgery, and the Canadian Society of Cardiac Surgeons have developed this document, endorsed by the STS and affirmed by the Society of Cardiovascular Angiography and Interventions and the Canadian Association of Interventional Cardiology, to provide guidance for cardiac procedure deferment and intervention timing for preoperative patients diagnosed with COVID-19. This document is intended for the perioperative cardiac surgical team and outlines the present state of the pandemic, the impact of COVID-19 on intervention outcome, and offers a recommended algorithm for individualized cardiac procedure triage and timing.


Asunto(s)
COVID-19 , Procedimientos Quirúrgicos Cardíacos , Cirujanos , Adulto , Canadá , Humanos , SARS-CoV-2 , Triaje/métodos
12.
J Extra Corpor Technol ; 54(3): 250-254, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36742219

RESUMEN

Interest in simulation has grown substantially, as has enthusiasm for team-based approaches to surgical training. In cardiothoracic surgery, the dynamic ability of the entire team is critical to emergent events. We developed innovative, interprofessional simulation events to improve team confidence. Two separate simulations event replicating critical steps and potential crises of cardiopulmonary bypass (CPB) were attended by members of the multidisciplinary cardiothoracic team. Standard CPB equipment, echocardiography, an app to control vital signs, and typical operating room tools for cannulation were all used. Participant started at their typical roles, then rotated into unfamiliar roles for subsequent simulations. Survey and Likert scale self-assessment tools were used to determine outcomes. Statistical analysis compared results. Two separate events were attended by a total of 37 team members (17 facilitators and 20 participants). Participants rotated roles through 12 routine and high-risk scenarios for instituting and separating from CPB. Participant evaluation results were highly favorable, with requests for further similar events. Objectively, the mean score for self-assessment rose significantly comparing the pre- and post-simulation assessments. Despite a small sample size, these differences did reach statistical significance in two categories: iatrogenic dissection (p 0.008), and emergent return to CPB (p 0.016). In our experience, high-fidelity interprofessional simulation promoted team communication and confidence for key scenarios related to institution of and separation from CPB.

13.
Am J Case Rep ; 22: e932073, 2021 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-34675166

RESUMEN

BACKGROUND Percutaneous transvenous lead extraction (TLE) of cardiac implantable electronic devices can be performed with a high success rate. However, TLE has its limitations and challenges. Recognizing the challenges at an early stage during the procedure is vital for appropriate patient management. We present a challenging case of implantable cardioverter-defibrillator (ICD) lead extraction in which we aborted TLE in favor of elective surgical extraction (SE). This potentially prevented a major catastrophic complication of vascular tear, which would have required an emergent thoracotomy. CASE REPORT A 37-year-old woman with history of hypertrophic cardiomyopathy had a primary prevention dual-chamber ICD implant in 2001 and underwent right ventricular ICD lead revision in 2009 due to lead fracture. In 2019, she was again found to have right ventricular ICD lead malfunction. TLE was attempted, but no meaningful progression could be made despite using multiple extraction tools. Therefore, TLE was aborted in favor of SE. During elective SE, significant adhesions were noted, and the innominate vein was completely avulsed during removal of the leads, requiring venous reconstruction by the vascular surgery team. After SE and vascular reconstruction, an epicardial ICD system was placed, and the patient had an uneventful postoperative recovery. CONCLUSIONS This case report highlights the limitations of TLE and the importance of recognizing them in a timely manner. In all challenging cases, conversion to elective SE should be considered to avoid potential injuries warranting emergent surgical repair.


Asunto(s)
Cardiomiopatía Hipertrófica , Desfibriladores Implantables , Adulto , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/terapia , Desfibriladores Implantables/efectos adversos , Remoción de Dispositivos , Femenino , Humanos , Adherencias Tisulares , Resultado del Tratamiento
14.
Ann Thorac Surg ; 112(5): 1707-1715, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34370980

RESUMEN

EXECUTIVE SUMMARY: Cardiothoracic surgical patients are at risk of increased coronavirus disease severity. Several important factors influence the administration of the coronavirus disease vaccine in the perioperative period. This guidance statement outlines current information regarding vaccine types, summarizes recommendations regarding appropriate timing of administration, and provides information regarding side effects in the perioperative period for cardiac and thoracic surgical patients.


Asunto(s)
Vacunas contra la COVID-19/farmacología , COVID-19/prevención & control , Enfermedades Cardiovasculares/cirugía , Atención Perioperativa/métodos , Guías de Práctica Clínica como Asunto , Procedimientos Quirúrgicos Torácicos , Vacunación/normas , COVID-19/epidemiología , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Humanos , Pandemias
15.
JTCVS Open ; 6: 193-197, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36003564

RESUMEN

Visual representation of the impact and controversy surrounding the timing of initiation for renal-replacement therapy for acute kidney injury after cardiac surgery. On the left side of the image is the impact of acute kidney injury on postoperative heart surgery patients. On the right are the considerations a provider must undertake when determining the appropriating timing for renal-replacement therapy for individual patients.

18.
J Card Surg ; 35(9): 2208-2215, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32720339

RESUMEN

BACKGROUND: Postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) represents a unique subset of critically ill patients, with a paucity of data regarding long-term survival and correlated characteristics. We present a retrospective cohort of PC-ECMO patients, with outcomes at 1 and 3 years. METHODS: Data were collected retrospectively for all patients requiring ECMO within 72 hours of an index cardiac operation (excluding assist devices and transplants). Primary outcomes were the ability to wean from ECMO, hospital survival, and long-term survival. RESULTS: Thirty-one patients required PC-ECMO, representing a total of 172 days of ECMO support. Overall survival data were the ability to wean 58%, hospital survival 52%, 1-month survival 42%. The estimated 12- and 36-month survival for all PC-ECMO patients was 35% and 29%, respectively. Twelve and 36-month survival for all hospital survivors was 62% and 56%. Operative times, the Society of Thoracic Surgeons risk scores, type of operation, open chest status, hemorrhage, and cannulation location, and timing were all compared. Centrally cannulated patients were more likely to wean from ECMO (83% vs 44%; P = .03), and survive hospitalization (75% vs 36%; P = .04) and trended toward long-term survival benefit (67% vs 33%; P = .06). Otherwise, no statistically significant relationships were observed. CONCLUSIONS: Central cannulation may provide benefits in the postcardiotomy patient, compared to peripheral strategies. Twelve and 36-month survival for all PC-ECMO patients was 35% and 29%. For hospital survivors, 12 and 36-month survival 62% 56% at 36. These data support PC-ECMO as a reasonable salvage strategy, with midterm survival comparable to other surgically treated diseases.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Oxigenación por Membrana Extracorpórea , Humanos , Oxigenadores de Membrana , Estudios Retrospectivos , Choque Cardiogénico
20.
J Card Surg ; 35(7): 1444-1451, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32383223

RESUMEN

BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) in the postoperative period has expanded to include a variety of noncardiotomy procedures. It is important to investigate outcomes for this uniquely ill subset of patients as currently published data on this subject is limited. METHODS: All ECMO events at our institution from 2006 to 2017 were retrospectively considered. Patients were grouped into a postoperative noncardiotomy (PNC) cohort (n = 20) and a larger control cohort (n = 220). For additional analysis, the PNC cohort was further split into a liver transplant group (n = 4) and thoracic surgery group (n = 10). Basic demographics, medical history, type of operation performed, indication for support, and survival data were collected on all patients. Appropriate statistical analyses were performed and a P < .05 was considered statistically significant. RESULTS: Twenty PNC-ECMO patients were identified. The indications for support were respiratory failure, cardiac arrest, and cardiogenic shock. PNC patient survival was similar to our control cohort, as well as extracorporeal life support organization (ELSO) published data with 55% weaning off ECMO and 50% surviving to discharge. Twelve-month predicted survival was 40%. Post thoracic surgical patients were reviewed, and their survival rates were similar to the larger control cohort as well. There were no survivors in the liver transplant group. CONCLUSIONS: Despite recent noncardiotomy surgery, patients who required ECMO for salvage in the postoperative period showed similar outcomes compared to our larger cohort and to published ELSO data, and reasonable long-term survival outcomes. This suggests that ECMO may be applied to a variety of postoperative settings with outcomes on par with nationally published results.


Asunto(s)
Oxigenación por Membrana Extracorpórea/mortalidad , Paro Cardíaco/terapia , Trasplante de Hígado , Complicaciones Posoperatorias/terapia , Insuficiencia Respiratoria/terapia , Choque Cardiogénico/terapia , Procedimientos Quirúrgicos Torácicos , Adulto , Anciano , Estudios de Cohortes , Femenino , Paro Cardíaco/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Insuficiencia Respiratoria/mortalidad , Estudios Retrospectivos , Choque Cardiogénico/mortalidad , Tasa de Supervivencia , Resultado del Tratamiento , Adulto Joven
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