Exception-Status Listing: A Critical Pathway to Heart Transplantation for Adults With Congenital Heart Diseases.

Adults with congenital heart diseases may not be candidates for conventional therapies to control ventricular systolic dysfunction, including mechanical circulatory support, which moves potential heart-transplantation recipients to a listing status of higher priority. This results in longer waitlist times and greater mortality rates. Exception-status listing allows a pathway for this complex and anatomically heterogenous group of patients to be listed for heart transplantation at appropriately high listing status. Our study queried the United Network for Organ Sharing registry to evaluate trends in the use of exception-status listing among adults with congenital heart diseases awaiting heart transplantation. Uptrend in the use of exception-status listing precedes the new allocation system, but it has been greatest since changes were made in the allocation system. It continues to remain a vital pathway for adults with congenital heart disease (whose waitlist mortality rates are often not characterized adequately by using the waitlist-status criteria) timely access to heart transplantation.

Comparing postoperative outcomes after free flap surgery in a specialty step-down unit vs nonspecialty intensive care unit.

BACKGROUND: To determine if there was a difference in postoperative outcomes of head and neck free flap reconstruction patients treated in a specialty step-down unit compared to a nonspecialty intensive care unit (ICU). METHODS: A retrospective review was performed of all patients who underwent free flap reconstruction for head and neck defects from 2014 to 2017 at Loyola University Medical Center. Patients managed postoperatively in the ICU were compared to patients managed in a specialty step-down unit. Postoperative outcomes, length of stay, and readmission were compared. RESULTS: Three hundred and five patients were included in the study. Patients managed postoperatively in the specialty step-down unit had comparable rates of postoperative complications and flap failure as ICU patients. Step-down patients had significantly shorter lengths of stay (Mdn = 5 days, IQR = 5-7 days) than patients in the ICU (Mdn = 6 days, IQR = 5-6 days; P < .001).