Cardiothoracic RSS : Gourt

Cardiothoracic Surgeon with Endovascular Skills Needed in Scenic Coastal Oregon - Close to PAC-10 Un :: Oregon :: CompHealth Inc

Job 6512123 Opportunity for a Board Certified or Board Eligible Cardiothoracic Surgeon, with Endovascular training and skills. Prefer recently trained surgeons and prefer a 2009 or 2010 grad. No J1s

Cardiothoracic Surgeon Needed for Full Time Staff Position - North of New York City :: New York :: CompHealth Inc

Job 6512841 Board Certified Thoracic-CVT Surgeon Experienced Cardiothoracic Surgeon required Vascular skills desirable Competitive salary and benefits package Great location outside of Metro area -

Academic Transplant Surgery - Heart / Lung Opportunity in the Sunshine State :: Florida :: CompHealth Inc

Job 6512670 Transplant Surgery opportunity Academic employed position with the medical center Competitive salary and benefits package Growing academic program Excellent Metro Location Must be Fellowship

CardioThoracic Surgery with Big Volume of Open Hearts :: Tennessee :: CompHealth Inc

Job 6510246 SSG of CVT Surgeons Hospital based group Call of 1:3 Must have MIS Cardiac Surgery Skills Work out of one large hospital with 500+ beds Cardiac, thoracic and vascular available No State

Northern California - 1 Hour to the Bay Area :: California :: Cardiothoracic Surgery - Group Practice-California

Group Practice Northern California One hour to the East Bay In order to qualify for this opportunity, the Heart Surgeon must be Trained and experienced in Robotics (da vinci Robot onsite) Strong

CVT Practice Opportunity in a Great Location :: Alabama :: CompHealth Inc

Job 6511766 Board Certified or Board Eligible Thoracic surgeon, CVT Fellowship trained Must do off pump procedures Partnership track with CVT surgery group Excellent location for family living - great

Cardiothoracic surgeon needed in Iowa :: Iowa :: LocumTenens.com

Cardiothoracic Surgeon needed in Iowa From blues and covered bridges to antique cars and balloon launches, Iowa's year long schedule of events offers something for everyone! Practice Description: Cardiothoracic

Call for information :: Illinois :: Inhouse Physician Recruiters Network

The In-House Physician Recruiter Network, composed of over 500 hospital recruiters, represents over 10,000 hospitals and clinics. Our Network's special feature is to showcase outstanding physicians (who

Wilkes-Barre :: Pennsylvania :: Community Health Systems

A board eligible or board certified cardiothoracic surgeon is being sought by Wilkes-Barre General Hospital. Contact: Joyce Y. McCuller Email: joyce_mcculler@chs.net Phone: 888-373-9600, x7451 Fax:

SouthEast :: Alabama :: Intelligent Placement Solutions, Inc

Join two excellent surgeons. There is a very demonstrated need forr your services. Dedicated and skilled practitioners only need apply. Client ID: 1044391613 Email: admin@jobs4med.com Web: www.jobs4med.com

Statewide :: Virginia :: The Doctor Job

Looking for a job in a big city? Even if you've heard that a market is "saturated", we can help! Many job openings for physicians may be hidden and unavailable unless you know where to look. An excellent

Statewide :: Texas :: The Doctor Job

Statewide :: Pennsylvania :: The Doctor Job

Statewide :: New York :: The Doctor Job

Statewide :: Indiana :: The Doctor Job

Statewide :: Illinois :: The Doctor Job

Statewide :: District of Columbia :: The Doctor Job

Medford :: Oregon :: Providence Health & Services

Medford, Oregon Providence Health & Services is seeking an experienced Cardiothoracic Surgeon to join its physician-led multi-specialty group in beautiful southern Oregon. Candidates interested in this

Hanover :: New Hampshire :: New England Physician Recruitment Center

Cardiothoracic Surgery at Dartmouth-Hitchcock Medical Center is seeking a highly qualified BE/BC cardiothoracic surgeon to join a busy adult cardiac surgical practice in an integrated, multidisciplinary

Joplin :: Missouri :: Heart & Vascular, PC

CV Surgeon needed to join busy cardiovascular/thoracic surgical practice. Very unique peripheral vascular case load with heavy emphasis on endovascular interventions. Regional tertiary referral

Penn Cardiac Care Ranked 12th in Nation

Penn Cardiac Care at the Hospital of the University of Pennsylvania has been ranked 12th in the nation, and best in the Philadelphia region, for heart care and heart surgery by U.S.News and World Report's 2008 Best Hospitals ranking. Since 1990, U.S.News has published this annual special issue, which provides a ranking of hospital quality of care on a nationwide basis and is meant to help consumers make informed decisions when looking for hospital care.

Join the 2008 Start Heart Walk

The 10th Annual Heart Walk will take place on Saturday, November 15, 2008 at Citizen’s Bank Park - Home to our own Philadelphia Phillies! We encourage you to join Penn’s Heart Walk team today! Your participation will help support Penn Cardiac Care and the American Heart Association’s efforts to develop programs and research dedicated to finding better treatments and cures for heart disease and stroke. These issues truly affect our business and touch our families, friends, associates, and the communities we serve.

Penn Cardiovascular Institute

Over the past decade, cardiovascular research and clinical care at the University of Pennsylvania has grown tremendously with many nationally and internationally recognized research and clinical programs. The Penn Cardiovascular Institute (CVI) was established in 2005 to build bridges between scientists and clinicians. This collaborative spirit has facilitated the development of novel treatments and therapies, which patients at Penn have been among the first in the world to benefit from. Our researchers and clinicians continue to discover new breakthroughs that lead to life-saving procedures, devices and medications that will positively impact the care of individuals with cardiovascular disease.

Women's Heart Health Program at Mercer Bucks

To help improve the cardiovascular health of women, Penn Cardiac Care at Mercer Bucks introduces the Women’s Heart Health Program. The Women’s Heart Health Program’s mission is to help improve the cardiac health of women by offering free screenings, comprehensive risk factor assessments and the knowledge to create healthy lives and lifestyles.

HUP Heart Transplant Recipients Compete in 2008 U.S. Transplant Games

In July, the 2008 U.S. Transplant Games where held in Pittsburgh, PA, where more than 1,200 men, women and children have traveled from across the country to prove that transplantation works. Participants all received life-saving transplants and celebrated their success by competing in these games.

New Physicians at Penn Cardiac Care

Read about new physicians and new practices here at University of Pennsylvania Health System.

Penn Cardiac Care Locations

Penn Cardiac Care's cardiologists and cardiothoracic surgeons see patients for evaluation and treatment at practices located in hospitals of the University of Pennsylvania Health System, and at other convenient locations throughout the region. To make an appointment with a Penn Cardiac Care physician or for more information, please call 800-789-PENN or visit www.pennhealth.com/cardiac.

Thomas B. Ferguson, MD: Recipient, 2009 Lifetime Achievement Award American Association for Thoracic Surgery [Lifetime Achievement Award]

The quality conundrum [Presidential Address]

The STICH trial: Misguided conclusions [Expert Commentary]

Simulation in cardiothoracic surgery: A paradigm shift in education? [Editorial]

Is transapical aortic valve implantation really less invasive than minimally invasive aortic valve replacement? [Acquired Cardiovascular Disease]

Background Transcatheter valve implants currently draw their justification for use from reduction of perioperative risk. However, patient age and comorbidities are independent predictors of adverse outcome after aortic valve replacement, regardless of surgical approach. Therefore, it is unclear whether transapical aortic valve implantation really improves outcomes in high-risk patients. Methods We included a total of 51 high-risk patients with severe aortic valve stenosis. Patients were allocated to transapical aortic valve implantation (n = 21) or minimally invasive aortic valve replacement via a partial upper sternotomy (n = 30), in a nonrandomized fashion. Patient age, preoperative comorbidities, and perioperative risk, expressed as logistic EuroSCORE (38% ± 14% vs 35% ± 9%), were matched between the 2 groups. Results Early morbidity and mortality were comparable between groups, but transapical aortic valve implantation was associated with shorter operative time (P = .004), ventilation time (P < .001), intensive care unit stay (P < .001), and hospital stay (P < .001). Thirty-day mortality was 14% (n = 3) in the transcatheter group versus 10% (n = 3) in the surgical group. After a mean follow-up of 12 ± 4 months (100% complete), there were a total of 5 (24%) deaths in the transapical group versus 5 (17%) deaths in the open surgery group. There was 1 intraoperative death in the transapical group versus none in the surgery group. In the transapical group, there were 2 re-explorations for bleeding, 2 intraoperative conversions, 1 case of prosthesis migration, and 2 impairments of coronary arteries. The surgery group included 1 re-exploration, 1 stroke, 1 pacemaker implantation for complete atrioventricular block, and 3 cases of atrial fibrillation. Conclusions Current data suggest a faster postoperative recovery after transapical aortic valve implantation, with early and late morbidity and mortality comparable with those of minimally invasive aortic valve replacement via partial upper sternotomy.

Discussion [Acquired Cardiovascular Disease]

Survival after transapical and transfemoral aortic valve implantation: Talking about two different patient populations [Acquired Cardiovascular Disease]

Objective Recently, suspicion had been expressed that survival might be impaired after antegrade transapical as opposed to retrograde transfemoral valve implantation in high-risk patients with aortic stenosis. We analyzed survival in patients undergoing transcatheter aortic valve implantation with special emphasis on the access site for implantation. Methods Between June 2007 and February 2009, 203 high-risk patients (EuroSCORE, 22% ± 14%; mean age, 81 ± 7 years) underwent transcatheter aortic valve implantation via a transapical (n = 50) or transfemoral (n = 153) access. The transapical implantation technique was chosen only in patients who had no access through diseased femoral arteries. Results Thirty-day survival was 88.8% after transfemoral versus 91.7% after transapical implantation (P = .918). The transapical group had a significantly higher preoperative brain natriuretic peptide value and a significantly higher incidence of peripheral vessel, cerebrovascular, and coronary heart disease. Death within 30 days was valve related in 25% (transapical) and 31% (transfemoral), cardiac in 25% and 13%, and noncardiac in 50% and 56%, respectively (no significant difference). Complications specific to the access site (peripheral vessel injury or apex complications) occurred in both groups, whereas neurologic events did not occur in the transapical group (P = .041). Conclusions Our patient and access site selection process, with the transfemoral technique considered the access site of first choice, results in comparable survival and morbidity for either transfemoral or transapical transcatheter aortic valve implantation. Both techniques are associated with certain access site–specific complications that require highly qualified management. The neurologic risk profile of the patients should be included in the decision-making process before transcatheter aortic valve implantation, inasmuch as neurologic events may be reduced with the transapical access.

Discussion [Acquired Cardiovascular Disease]

Selective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery [Acquired Cardiovascular Disease]

Introduction Selective antegrade cerebral perfusion is a well-described neuroprotective technique used in proximal aortic surgery. This study investigated whether selective antegrade cerebral perfusion is associated with improved outcomes in both emergency and elective settings compared with deep hypothermic circulatory arrest alone. Methods Retrospective review was performed for all cases of proximal aortic surgery between January 2004 and May 2007. Of these 271 patients, 105 had emergency and 166 had elective operation. Selection bias was controlled using propensity scoring methods. Multivariable logistic regression analysis was used to model adverse outcomes as a function of selective antegrade cerebral perfusion, emergency status, and their interaction, adjusted for the propensity score. Adjusted odds ratios were formulated with 95% confidence intervals. Results Operative mortality occurred in 12.1% (33/271) of patients: 8.8% (18/205) in patients with selective antegrade cerebral perfusion versus 22.7% (15/66) in those with deep hypothermic circulatory arrest alone (P = .003). Temporary neurologic dysfunction occurred in 5.9% (15/255) of patients: 4.5% (9/198) in selective antegrade cerebral perfusion versus 10.5% (6/57) in deep hypothermic circulatory arrest alone (P = .09). Stroke occurred in 4.3% (11/255) of patients with no difference between groups. In the elective setting, selective antegrade cerebral perfusion was associated with a significant decrease in operative mortality compared with deep hypothermic circulatory arrest alone. Overall, selective antegrade cerebral perfusion was associated with shorter intensive care unit and ventilator times and fewer renal and pulmonary complications. Significant multivariable predictors of operative mortality were emergency status, previous coronary surgery, and cardiopulmonary bypass time. Conclusions Use of selective antegrade cerebral perfusion confers a survival advantage during proximal aortic surgery that is most apparent in the elective setting. Improved resource utilization and fewer pulmonary and renal complications were observed in patients with selective antegrade cerebral perfusion.

Discussion [Acquired Cardiovascular Disease]

Mitral annular hinge motion contribution to changes in mitral septal-lateral dimension and annular area [Acquired Cardiovascular Disease]

Objective The mitral annulus is a dynamic, saddle-shaped structure consisting of fibrous and muscular regions. Normal physiologic mechanisms of annular motion are incompletely understood, and more complete characterization is needed to provide rational basis for annuloplasty ring design and to enhance clinical outcomes. Methods Seventeen sheep had radiopaque markers implanted; 16 around the annulus and 2 on middle anterior and posterior leaflet edges. Four-dimensional marker coordinates were acquired with biplanar videofluoroscopy at 60 Hz. Hinge angle was quantified between fibrous and muscular annular planes, with 0° defined at end diastole, to characterize its contribution to alterations in mitral septal–lateral dimension and 2-dimensional total annular area throughout the cardiac cycle. Results During isovolumic contraction (pre-ejection), hinge angle abruptly increased, reaching maximum (steepest saddle shape, change 18° ± 13°) at peak left ventricular pressure. During ejection, hinge angle did not change; it then decreased during early filling (change 2° ± 2°). Septal–lateral dimension and total area paralleled hinge angle dynamics and leaflet distance (anterior to posterior marker). Pre-ejection septal–lateral reduction was 13% ± 7% (3.3 ± 1.5 mm) from 9% muscular dimension fall and 18° ± 13° hinge angle increase. Conclusions Pre-ejection increase in hinge angle contributes substantially to septal–lateral and total area reduction, facilitating leaflet coaptation. Semirigid annuloplasty rings or partial bands may preserve hinge motion, but possible recurrent annular dilatation could result in recurrent mitral regurgitation. Long-term clinical studies are required to determine who might benefit most from preserving intrinsic hinge motion without compromising repair durability.

Discussion [Acquired Cardiovascular Disease]

Narrowing the gap: Early and intermediate outcomes after percutaneous coronary intervention and coronary artery bypass graft procedures in California, 1997 to 2006 [Acquired Cardiovascular Disease]

Objective Percutaneous coronary intervention is increasingly used to treat multivessel coronary artery disease. Coronary artery bypass graft procedures have decreased, and as a result, percutaneous coronary intervention has increased. The overall impact of this treatment shift is uncertain. We examined the in-hospital mortality and complication rates for these procedures in California using a combined risk model. Methods The confidential dataset of the Office of Statewide Health Planning and Development patient discharge database was queried for 1997 to 2006. A risk model was developed using International Classification of Diseases, Ninth Revision, Clinical Modification procedures and diagnostic codes from the combined pool of isolated coronary artery bypass graft and percutaneous coronary intervention procedures performed during 2005 and 2006. In-hospital mortality was corrected for "same-day" transfers to another health care institution. Early failure rate was defined as in-hospital mortality rate plus reintervention for another percutaneous coronary intervention or cardiac surgery procedure within 90 days. Results Coronary artery bypass graft volume decreased from 28,495 (1997) to 15,520 (2006), whereas percutaneous coronary intervention volume increased from 38,098 to 53,703. Risk-adjusted mortality rate decreased from 4.7% to 2.1% for coronary artery bypass graft procedures and from 3.4% to 1.9% for percutaneous coronary intervention. Expected mortality rate increased for both procedures. Early failure rate decreased from 13.1% to 8.0% for percutaneous coronary intervention and from 6.5% to 5.4% for coronary artery bypass graft. For the years 2004 and 2005, the risk of recurrent myocardial infarction or need for coronary artery bypass graft during the first postoperative year was 12% for percutaneous coronary intervention and 6% for coronary artery bypass grafts. Conclusion This study shows that as volume shifted from coronary artery bypass grafts to percutaneous coronary intervention, expected mortality increased for both procedures. Risk-adjusted mortality rate decreased for both procedures, more so for coronary artery bypass grafts, so that corrected in-hospital mortality rates essentially equalized at approximately 2.0% in 2006. The post-procedural risk of reintervention, death, or myocardial infarction within the first year was twice as high for percutaneous coronary intervention as for coronary artery bypass grafts.

Discussion [Acquired Cardiovascular Disease]

Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? [Acquired Cardiovascular Disease]

Objective Aneurysms or dissections can involve multiple aortic segments in patients with Marfan syndrome, requiring staged replacement of the entire aorta. The optimal treatment of descending aortic dissection in these patients is a major challenge. We investigated the feasibility and outcomes of endovascular repair of the descending aorta in patients already submitted to open aortic root/arch surgery. Methods From March 1998 to July 2008, 12 patients (10 male and 2 female patients; mean age, 37.8 ± 11.6 years) affected by Marfan syndrome underwent endovascular treatment for dissection of the descending aorta after previous open aortic root/arch surgery. Stent graft procedures were performed urgently in 5 patients and electively in 7 patients. Results Neither in-hospital deaths nor perioperative paraplegia or stroke occurred. Follow-up (median, 31 months; range, 3–57 months) was 100% complete. One patient needed surgical conversion for persistent type I endoleak, leading to false lumen expansion 3 months after endovascular repair. Extension of the dissection occurred in 2 patients 1 month and 2 years after the procedure, respectively. No late death or aortic rupture was observed. Conclusions Endovascular repair of the dissected descending thoracic aorta can be performed in patients with Marfan syndrome with a low risk of death or major complications. In case of staged procedures, stent graft treatment can be considered a possible alternative to open reoperation. Long-term durability remains to be determined.

Improved survival after coronary artery bypass grafting has not influenced the mortality disadvantage in patients with diabetes mellitus [Acquired Cardiovascular Disease]

Objectives We sought to compare mortality after coronary artery bypass grafting in patients with and without diabetes mellitus undergoing operations during different time periods. Methods We performed analyses of 12,415 primary isolated coronary artery bypass grafting operations performed during 1970–2003, with follow-up of 5-year mortality up to December 2006. Results The prevalence of diabetes mellitus continuously increased up to 25% among patients undergoing coronary artery bypass grafting in 2003. The 1892 patients with type 2 diabetes mellitus were older, more often female, and more frequently had cardiovascular risk factors, acute coronary syndrome, 3-vessel disease, and severely reduced left ventricular function than patients without diabetes mellitus. Early mortality was 3.4% in patients with diabetes mellitus versus 1.8% in patients without diabetes mellitus. The multivariable adjusted odds ratio was 2.0, and the 95% confidence interval was 1.4 to 2.7. Early adjusted mortality was significantly lower in patients operated on during 2000–2003 than those operated on during 1970–1989 in patients with diabetes mellitus (odds ratio, 0.3; 95% confidence interval, 0.1–0.9) and without diabetes mellitus (odds ratio, 0.4; 95% confidence interval, 0.2–0.7). Mortality until 5 years was 14.6% in patients with diabetes mellitus versus 8.3% in patients without diabetes mellitus (hazard ratio, 1.8; 95% confidence interval, 1.5–2.0). Five-year mortality was reduced by 40% in patients operated on during 2000–2003 compared with that seen in those operated on during 1970–1989 in patients with and without diabetes mellitus. Conclusions Diabetes mellitus was associated with an almost 2-fold increased risk of early and 5-year mortality. Early and late mortality were substantially reduced in patients with and without diabetes mellitus operated on more recently, but the mortality disadvantage associated with diabetes mellitus was not eliminated.

Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy [Acquired Cardiovascular Disease]

Objective False tendons in the left ventricle are commonly observed. Preliminary observations associate false tendons with less functional mitral regurgitation. Methods Echocardiograms demonstrating severe cardiomyopathy (ejection fraction ≤30%) were retrospectively examined for left ventricular false tendons. The ejection fraction, cause of left ventricular systolic dysfunction, left ventricular diastolic dimensions, severity of mitral regurgitation, mitral annular diameter, mitral valve coaptation depth, mitral valve coaptation area, and orientation of false tendon were evaluated. The patients with false tendons were compared with a control group with cardiomyopathy without false tendons. Results A cohort of patients (n = 82) with severe left ventricular systolic dysfunction (mean ejection fraction, 21%) and false tendons were compared with a control group with similar left ventricular dysfunction and no false tendons (n = 121; mean ejection fraction, 20%; P = .10). The patients with false tendons had similar left ventricular diastolic internal dimensions compared with the control group (5.99 and 6.18 cm, respectively; P = .086). Yet patients with false tendons had a very low incidence of severe functional mitral regurgitation compared with the control group (4.9% vs 27%, P < .001). Patients with false tendons had significantly smaller mitral annular diameters (3.57 vs 4.03 cm, P < .001), shorter mitral valve coaptation depths (0.89 vs 1.24 cm, P < .001), and reduced coaptation areas (1.61 vs 2.52 cm2, P < .001) than the control group. The reduction of mitral regurgitation was more significant for patient with transverse midcavity false tendons. Conclusions Patients with false tendons and cardiomyopathy have less severe mitral regurgitation. The mechanism for the reduction in functional mitral regurgitation might be less mitral valve deformation, specifically lower coaptation depth and coaptation area when a false tendon is present.

Endovascular treatment of acute traumatic thoracic aortic injuries: A retrospective analysis of 20 cases [Acquired Cardiovascular Disease]

Objective We report our 10-year experience in the endovascular treatment of acute traumatic thoracic aorta rupture at the Hospital Clinic. Methods We reviewed 20 patients with an acute traumatic thoracic aorta lesion treated with a thoracic endograft between August 1997 and July 2007. All patients had multi-trauma resulting from high-velocity accidents or accidents with great impact. The diagnosis of aortic injury was made on a clinical basis and conventional imaging, confirmed by computed tomographic angiography. The following parameters were studied: age, sex, type and site of the lesion, type of endovascular graft, endovascular operation time, length of stay in the intensive care unit, length of stay in the hospital, immediate and perioperative complications, and mortality. Follow-up data were recorded, consisting of clinical visits, computed tomographic angiography, and plain chest radiographs at regular intervals (3, 6, and 12 months and every subsequent year). The mean follow-up was 58 months. Results All endovascular procedures were technically successful, and the mean operating time for the endovascular procedure was 74 minutes (range, 55–130 minutes). We recorded an external iliac lesion during the procedure as an unique immediate complication, and it was corrected by an iliofemoral bypass. The only perioperative death (perioperative mortality rate of 5%) was unrelated to the aortic rupture or stent placement. There was no intervention-related mortality during the follow-up. Postoperative data showed no severe endovascular graft- or procedure-related morbidity. We recorded 2 cases of stent fracture, diagnosed by chest radiograph and computed tomographic angiography, without clinical impact or signs of endoleak. Conclusion The short- and mid-term results of immediate endovascular repair of traumatic aortic injuries are promising, especially when compared with open surgical treatment, indicating that endovascular therapy is preferable in patients with multi-trauma and traumatic ruptures of the thoracic aorta. Nevertheless, long-term follow-up data are necessary to assess the overall durability of this procedure, considering the young age of these patients. The long-term follow-up results will determine whether endovascular treatment should replace open surgery as first-line therapy in thoracic aortic injuries.

An empirically based tool for analyzing mortality associated with congenital heart surgery [Congenital Heart Disease]

Objective Analysis of congenital heart surgery results requires a reliable method of estimating the risk of adverse outcomes. Two major systems in current use are based on projections of risk or complexity that were predominantly subjectively derived. Our goal was to create an objective, empirically based index that can be used to identify the statistically estimated risk of in-hospital mortality by procedure and to group procedures into risk categories. Methods Mortality risk was estimated for 148 types of operative procedures using data from 77,294 operations entered into the European Association for Cardiothoracic Surgery (EACTS) Congenital Heart Surgery Database (33,360 operations) and the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (43,934 patients) between 2002 and 2007. Procedure-specific mortality rate estimates were calculated using a Bayesian model that adjusted for small denominators. Each procedure was assigned a numeric score (the STS–EACTS Congenital Heart Surgery Mortality Score [2009]) ranging from 0.1 to 5.0 based on the estimated mortality rate. Procedures were also sorted by increasing risk and grouped into 5 categories (the STS–EACTS Congenital Heart Surgery Mortality Categories [2009]) that were chosen to be optimal with respect to minimizing within-category variation and maximizing between-category variation. Model performance was subsequently assessed in an independent validation sample (n = 27,700) and compared with 2 existing methods: Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories and Aristotle Basis Complexity scores. Results Estimated mortality rates ranged across procedure types from 0.3% (atrial septal defect repair with patch) to 29.8% (truncus plus interrupted aortic arch repair). The proposed STS–EACTS score and STS–EACTS categories demonstrated good discrimination for predicting mortality in the validation sample (C-index = 0.784 and 0.773, respectively). For procedures with more than 40 occurrences, the Pearson correlation coefficient between a procedure's STS–EACTS score and its actual mortality rate in the validation sample was 0.80. In the subset of procedures for which RACHS-1 and Aristotle Basic Complexity scores are defined, discrimination was highest for the STS–EACTS score (C-index = 0.787), followed by STS–EACTS categories (C-index = 0.778), RACHS-1 categories (C-index = 0.745), and Aristotle Basic Complexity scores (C-index = 0.687). When patient covariates were added to each model, the C-index improved: STS–EACTS score (C-index = 0.816), STS–EACTS categories (C-index = 0.812), RACHS-1 categories (C-index = 0.802), and Aristotle Basic Complexity scores (C-index = 0.795). Conclusion The proposed risk scores and categories have a high degree of discrimination for predicting mortality and represent an improvement over existing consensus-based methods. Risk models incorporating these measures may be used to compare mortality outcomes across institutions with differing case mixes.

Improved management of systemic venous anomalies in a single ventricle: New rationale [Congenital Heart Disease]

Objectives Two innovative surgical approaches addressing systemic venous anomalies in single-ventricle patients are evaluated. Methods Between 2003 and 2007, 7 patients underwent a unifocal bilateral bidirectional cavopulmonary anastomosis, and 5 patients underwent a hepatoazygos venous connection associated with a previous (n = 4) or concomitant (n = 1) Kawashima operation. Computational fluid dynamics simulations allowed investigation of 2 sets of comparative models: (1) bifocal versus unifocal bilateral bidirectional cavopulmonary anastomosis and (2) classic hepatic vein–pulmonary artery channel versus hepatoazygos direct anastomosis for Fontan completion after or combined with the Kawashima operation. Results There was 1 hospital death in the unifocal bilateral bidirectional cavopulmonary anastomosis group. At a mean follow-up of 15.6 ± 7.40 months after a unifocal bilateral bidirectional cavopulmonary anastomosis and of 38.7 ± 13.2 months after direct hepatoazygos venous connection, respectively, all 11 survivors are in New York Heart Association class I with functional anastomoses. Computational assessment of bifocal bilateral bidirectional cavopulmonary anastomosis demonstrated weak perfusion between caval veins against symmetric and steady bilateral flow fields in the unifocal arrangement. In the classic post-Kawashima Fontan completion model, the hepatic venous flow to the pulmonary artery was held back by means of preponderant opposite flow, whereas in the direct hepatoazygos venous connection model, the hepatic venous flow merged smoothly into the azygos vein. Power-loss calculation showed no significant difference between bifocal and unifocal bilateral bidirectional cavopulmonary anastomosis topology, whereas the hepatoazygos connection clearly had better energy preservation than the classical connection. Conclusions This limited clinical and computational fluid dynamics assessment suggests the efficacy of this new rationale to reduce the additional thrombotic risks produced by systemic venous anomalies in single-ventricle patients.

The potential of disproportionate growth of tricuspid valve after decompression of the right ventricle in patients with pulmonary atresia and intact ventricular septa [Congenital Heart Disease]

Objective Tricuspid valve size is the major determinant of outcomes for patients with pulmonary atresia with intact ventricular septum. Lack of right ventricle–pulmonary artery continuity is associated with poor tricuspid valve growth (decrement in Z-value). However, most reports did not show evidence for disproportionate growth of the tricuspid valve after establishment of right ventricle–pulmonary artery continuity. Methods We studied 40 patients with pulmonary atresia with intact ventricular septum who underwent initial right ventricular decompression for planned staged repair. The initial Z-value of the tricuspid valve diameter (Zt1) was obtained from the echocardiography-derived normal value. The late Z-value (Zt2) was measured before definitive repair or the last available Z-value, if definitive repair was not yet reached. The factors associated with the changes of Z-values (Zt2 – Zt1) were analyzed. Results The mean initial tricuspid Z-value (Zt1) was –6.2 ± 3.5. After treatment (Zt2), the mean Z-value was –6.0 ± 3.4 (n = 34). Overall, the tricuspid Z-values did not change. Individually, the change in Z-value (Zt2 – Zt1) was larger than +2 in 11 (32%) patients and smaller than –2 in 6 (18%) patients. Increases in Z-value (Zt2 – Zt1) were significantly associated with right ventricular pressure/left ventricular pressure ratio measured after initial palliation (r = –0.54; P = .001) and the initial tricuspid valve Z-value (Zt1) (r = –0.40; P = .02). Conclusions Disproportional growth of the tricuspid valve can occur, especially in patients with small tricuspid valves and lower right ventricular pressures after decompression. The findings support the possibility of neonates with small tricuspid valves undergoing biventricular repair after right ventricular decompression surgery.

Results of surgical repair of atrioventricular septal defect with double-orifice left atrioventricular valve [Congenital Heart Disease]

Objective The outcome of surgical correction of atrioventricular septal defect with double-orifice left atrioventricular valve has improved in recent years but is still reported to be associated with high mortality and reoperation rates. Controversy exists about the management of the accessory orifice. We evaluated our results with correction of atrioventricular septal defect with double-orifice left atrioventricular valve. Methods Between 1975 and 2006, 21 patients underwent correction of atrioventricular septal defect with double-orifice left atrioventricular valve. Clinical data were obtained by means of retrospectively reviewing inpatient and outpatient medical records. To evaluate the influence of double-orifice left atrioventricular valve on mortality and the need for reoperation, a comparison was made with 291 consecutive patients who, during the same period, underwent correction of atrioventricular septal defect without double-orifice left atrioventricular valve. Results None of the 21 patients with double-orifice left atrioventricular valve had undergone a previous operation. The accessory orifice was managed with different techniques depending on the severity of the regurgitation. There was no in-hospital mortality, and there were 3 late deaths. Seven patients required 12 reoperations, 7 for left atrioventricular valve insufficiency. Double-orifice left atrioventricular valve had no influence on mortality but was a significant predictor for reoperation compared with repair of atrioventricular septal defect without double-orifice left atrioventricular valve. At the latest follow-up, all 18 survivors were in New York Heart Association functional class I without medication. Only 1 patient showed residual mild left atrioventricular valve insufficiency. Conclusion Atrioventricular septal defect with double-orifice left atrioventricular valve can be repaired with low mortality. However, double-orifice left atrioventricular valve is a predictor for reoperation. The accessory orifice is often competent and should then be left untouched. If regurgitation of the accessory orifice is present, this is best managed with suture or patch closure.

Preoperative lymphopenia is a predictor of postoperative adverse outcomes in children with congenital heart disease [Congenital Heart Disease]

Objective Lymphopenia is a predictor of adverse clinical outcomes in adults with various systemic diseases. We hypothesized that preoperative absolute lymphopenia (absolute lymphocyte count of less than 3000 cells/µL) is associated with adverse postoperative outcomes in children with congenital heart disease undergoing corrective or palliative surgery on cardiopulmonary bypass during the first 2 years of life. Methods A retrospective single center cohort study was performed. Categorical variables were analyzed with the 2 test. Preoperative variables were analyzed with logistic and linear regression analysis to determine whether they were associated with adverse outcomes. Results Analysis was performed on 280 patients, of whom 124 were female and 156 were male. Seventy-one patients were neonates (≤30 days) at the time of the operation. Ninety patients had an absolute lymphocyte count of less than 3000 cells/µL before the operation. Regression models showed that RACHS-1 categories 5 and 6, age, and preoperative lymphopenia were significantly associated with postoperative mortality (P < .0006). Within RACHS-1 groups, lymphopenia remained a significant predictor of mortality for patients in RACHS categories 3 and 4. Lymphopenia and age were associated with longer length of stay and length of mechanical ventilation within RACHS categories 1 to 4 (P < .05). Preoperative lymphopenia was the only predictor of use of postoperative nitric oxide (P < .05). Conclusions Preoperative lymphopenia is a predictor of adverse postoperative outcomes in children with congenital heart disease who undergo a corrective or palliative procedure with cardiopulmonary bypass during the first 2 years of life.

Aggressive surgical treatment of multidrug-resistant tuberculosis [General Thoracic Surgery]

Objective Because extensively drug-resistant tuberculosis has emerged, adequate control of drug-resistant tuberculosis has become increasingly important. We report on our experience using liberal adjuvant resectional surgery as part of aggressive treatment for multidrug-resistant tuberculosis. Methods We retrospectively reviewed the records of 56 consecutive patients who underwent pulmonary resections for multidrug-resistant tuberculosis between January 2000 and June 2007. There were 42 males and 14 females (mean age, 46 years; range, 22-64 years). Isolates were resistant to a mean of 5.6 drugs (range, 2-10 drugs). Multi-drug regimens employing 3 to 7 drugs (mean, 4.6 drugs) were initiated in all patients. Indications for surgery were a high risk of relapse for 37 patients, persistent positive sputum for 18, and 1 with associated empyema. Results The 56 patients underwent 61 pulmonary resections (3 completion pneumonectomies, 19 pneumonectomies, 33 lobectomies, and 6 segmentectomies). Bronchial stumps were reinforced with muscle flaps in 54 resections. Operative mortality and morbidity rates were 0% and 16%, respectively. All patients attained postoperative sputum-negative status. Relapse occurred in 5 patients; 3 were converted by a second resection, and 1 responded to augmentation of chemotherapy. Late death occurred for 2 patients without evidence of relapse. Among 54 survivors, 53 (98%) were considered cured. Conclusion Surgical treatment that complements medical treatment has proved safe and efficacious for patients with multidrug-resistant tuberculosis. In an era with extensively drug-resistant tuberculosis, an aggressive treatment approach to multidrug-resistant tuberculosis continues to be justified until a panacea for this refractory disease is available.

Discussion [General Thoracic Surgery]

Reconstruction of the pulmonary artery for lung cancer: Long-term results [General Thoracic Surgery]

Objective Reconstruction of the pulmonary artery in association with lung resection is technically feasible with low morbidity and mortality. To assess long-term outcome, we report our 20-year experience. Methods Between 1989 and 2008, we performed pulmonary artery reconstruction in 105 patients with non–small cell lung cancer (tangential resections not included). Twenty-seven patients received induction therapy. We performed 47 pulmonary artery sleeve resections, 55 reconstructions by pericardial patch (with 3 left pneumonectomies under cardiopulmonary bypass), and 3 by pericardial conduit. In 65 patients, a bronchial sleeve resection was associated; in 6 cases superior vena caval reconstruction was also required. Fifteen patients had stage IB disease, 37 stage II, 31 IIIA, and 22 IIIB. Sixty-one patients had epidermoid carcinoma, and 38 adenocarcinoma. Mean follow-up was 46 ± 40 months. Results The procedure–related complications were 1 pulmonary artery thrombosis requiring completion pneumonectomy and 1 massive hemoptysis leading to death (operative mortality, 0.95%); 28 patients had other complications, with the most frequent prolonged air leakage. Overall 5-year survival was 44%. Five- and 10-year survivals for stages I and II versus stage III were, respectively, 60% versus 28% and 25% versus 12%. Five-year survivals were 52.6% for N0 and N1 nodal involvement versus 20% for N2; 10-year survivals were 28% versus 3%. Multivariate analysis yielded induction therapy, N2 status, adenocarcinoma, and isolated pulmonary artery reconstruction as negative prognostic factors. Conclusions Pulmonary artery reconstruction is safe, with excellent long-term survival. Our results support this technique as an effective option for patients with lung cancer.

Discussion [General Thoracic Surgery]

Elongation gastroplasty with transverse fundoplasty: The Jeyasingham repair [General Thoracic Surgery]

Objective Surgical management of massive hernias and complex gastroesophageal reflux disease requires a tension-free repair with reliable reflux control. The aim of this observation was to evaluate the functional results of a modified Collis-Nissen gastroplasty with a transverse widening fundoplasty. Methods Between 1995 and 2007, 26 patients underwent a 3-cm cut elongation gastroplasty with a transverse widening of the fundus followed by a 3-cm total (n = 24) or partial (n = 2) fundoplication. Indications for the operation were symptomatic massive hiatal hernias (n = 4), hiatal hernias with Barrett's esophagus (n = 8), or correction of previously failed antireflux fundoplications (n = 14). Barrett's esophagus was documented in 19 of the 26 patients. Pre- and postoperative assessment included symptoms, barium swallow, endoscopy, manometry, and 24-hour pH monitoring. Results There was no postoperative mortality. Complications were recorded in 6 patients. Median follow-up was 105 months. Reflux symptoms present in all patients before the operation were found in 5 patients postoperatively (P < .001). Radiologic assessment documented an intact fundoplication in all patients. Lower esophageal sphincter gradient increased from a mean of 7.5 to 15 mm Hg (P = .003). Acid exposure (17% preoperatively) decreased significantly to 1% postoperatively (P < .001). Endoscopically, mucosal damage quantification decreased (3.1 preoperatively to 1.5 postoperatively; P < .001). All mucosal breaks healed but the columnar-lined metaplasia persisted. Conclusions This modified elongation gastroplasty provided a reliable repair for massive hernias, shortened Barrett's esophagus, and reoperations. The lower esophageal sphincter gradient was restored and remained stable. Reflux exposure was reduced, and acute mucosal damage disappeared. Columnar-lined metaplasia remained unchanged.

Reliability of positron emission tomography-computed tomography in identification of mediastinal lymph node status in patients with non-small cell lung cancer [General Thoracic Surgery]

Objective The involvement of mediastinal lymph nodes is a very important prognostic factor in patients with potentially resectable non–small cell lung cancer. Our aim in this study was to investigate the value of positron emission tomographic–computed tomographic scanning in staging lung cancer, especially for mediastinal lymph node evaluation, and to determine whether this could decrease the need for mediastinoscopy. Methods Seventy-eight patients with non–small cell lung cancer who were potential candidates for surgical resection and admitted to the thoracic surgery unit of our hospital from March 2006 to June 2008 joined this prospective study. Positron emission tomographic–computed tomographic scanning was performed as part of the prospective studies used to diagnose or stage the tumors. All 78 patients underwent tissue sampling of mediastinal lymph nodes to compare these with imaging results. The diagnostic efficacy of the computed tomographic and positron emission tomographic–computed tomographic scans compared with histopathologic findings were calculated with sensitivity, specificity, positive and negative predictive values, and accuracy. Results Final histology was available on 397 lymph node stations (N1, N2, and N3) sampled from 78 patients during mediastinoscopy or surgical intervention. Sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing thoracic computed tomographic scanning were 45.4%, 80.5%, 27.7%, and 90%, respectively. The accuracy of computed tomographic scanning was 75.6%. The sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing positron emission tomographic–computed tomographic scanning were 81.8%, 89.5%, 56.2%, and 96.7%, respectively. Conclusion There is a need for mediastinoscopy in positron emission tomographic–computed tomographic scanning–positive mediastinal lymph nodes, but it might not be necessary for positron emission tomographic–computed tomographic scanning–negative lymph nodes.

Routine surgical videothoracoscopy as the first step of the planned resection for lung cancer [General Thoracic Surgery]

Objectives Notwithstanding preoperative staging, a number of procedures still end in an exploratory thoracotomy as a result of unexpected findings. The aim of this work is to evaluate the validity of routine videothoracoscopy, performed as the first step of every planned resection for non–small cell lung cancer, to assess tumor resectability and feasibility of the resection through thoracoscopy. Methods and Results From November 1991 to December 2007, in our department, 1306 patients with non–small cell lung cancer, judged operable at conventional staging, underwent videothoracoscopy before the operation. Thoracoscopy revealed inoperability in 58 (4.4%) patients, mostly owing to pleural dissemination (2.5%) or mediastinal infiltration (1.7%). In the remaining 1248 (95.6%), thoracoscopy did not reveal inoperability. Of these, 449 (34.4%) underwent thoracoscopic resection. The other 799 (61.2%) underwent thoracotomy: 767 underwent resection, but 32 (2.5%) had an exploratory thoracotomy. Thoracoscopy had suggested unresectability in 7 (0.5%) patients, had been incompletely carried out in 4 (0.3%), and was unfeasible in 21 (1.6%) owing to insurmountable technical reasons. In our previous series from 1980 to 1991 the exploratory thoracotomy rate had been 11.6%. In the present series, after the introduction of routine thoracoscopy in the staging process, the exploratory thoracotomy rate was 2.5%. Thoracoscopy was reliable in excluding unresectability (negative predictive value 0.97). The global percentage of correct staging was significantly better (P < .0001) by thoracoscopy (73.3%) than by computed tomography (48.7%). Considering T descriptor, video-assisted thoracic surgery correctly matched with final pathologic staging in 96.2% of patients. Conclusions Routine preliminary videothoracoscopy ensured assessment of tumor resectability and feasibility of the resection through thoracoscopy and limited unnecessary thoracotomies.

Warm-blood cardioplegic arrest induces selective mitochondrial translocation of protein kinase C{epsilon} followed by interaction with 6.1 inwardly rectifying potassium channel subunit in viable myocytes overexpressing urocortin [Evolving Technology/Basic Science]

Objective This study investigates the cardioprotective role and mechanism of action of urocortin in patients undergoing cardiac surgery, with respect to protein kinase C expression, activation, and relocation. Background Cardioplegic arrest and subsequent reperfusion inevitably expose the heart to iatrogenic ischemia/reperfusion injury. We previously reported that iatrogenic ischemia/reperfusion injury caused myocyte induction of urocortin, an endogenous cardioprotective peptide. Methods Two sequential biopsies were obtained from the right atrium of 25 patients undergoing coronary artery bypass grafting at the start of grafting (internal control) and 10 minutes after release of the aortic clamp. Results In hearts exposed to iatrogenic ischemia/reperfusion injury, induction of urocortin was documented at both the mRNA (255% of basic levels; P < .05) and the protein (4-fold increase; P < .01) levels. Iatrogenic ischemia/reperfusion injury also induced a selective increase of protein kinase C mRNA (225% of internal control; P < .05) and a 2-fold overexpression of total protein kinase C (P < .05), which paralleled a 2.9-fold increase in protein kinase C phosphorylation (P < .01). Mitochondrial translocation of activated protein kinase C was observed only in postcardioplegic samples, using both subcellular fractionation (P < .05) and immunostaining techniques (P < .05). Enhanced protein kinase C/mitochondria colocalization was selectively observed in viable myocytes, showing concurrently positive staining for urocortin (P < .05). Finally, co immunoprecipitation experiments documented an iatrogenic ischemia/reperfusion injury-enhanced physical interaction of phosphorylated protein kinase C with the 6.1 inwardly rectifying potassium channel subunit of the KATP channels (P < .05). Conclusion After iatrogenic ischemia/reperfusion injury, urocortin expression in viable cells selectively colocalized with enhanced phosphorylation and mitochondrial relocation of protein kinase C, suggesting a cardioprotective role for endogenous urocortin. The physical interaction of activated protein kinase C with 6.1 inwardly rectifying potassium channel, enhanced by cardioplegic arrest, may represent a conjectural mechanism of urocortin-mediated cardioprotection.

Animal models of tracheal allotransplantation using vitrified cryopreservation [Evolving Technology/Basic Science]

Objective Tracheal reconstruction continues to pose a significant challenge in thoracic surgery. The study objective was to develop a novel method to eliminate the antigenicity of tracheal allografts by using vitrified cryopreservation and present the experimental results after cervical tracheal replacement in rabbits. Methods Fifteen New Zealand rabbits, irrespective of gender, weighing 2.5 to 3.0 kg, were randomly divided into 3 groups: (A), the experimental group (n = 5), tracheal allotransplantation after 4 weeks of vitrified cryopreservation; (B), the negative control group (n = 5), fresh tracheal autotransplantation; and (C), the positive control group (n = 5), fresh tracheal segments implanted as allografts. The patency of implanted grafts, lymphocytic infiltrate, cartilage scores, and ink perfusion to evaluate revascularization were used to investigate the impact of vitrified cryopreservation on the antigenicity of tracheal grafts and vascular regeneration. Results Rabbits in groups A and B all had uneventful postoperative courses with patent lumens and structural integrity, with obvious vascular regeneration and less lymphocytic infiltrate. Although in excellent condition, animals were sacrificed after a short-term follow-up of 4 weeks for further examination as scheduled. In group C, massive lymphocytic infiltrate and inflammatory cells without noticeable revascularization were observed, and rabbits died within 2 weeks after surgery for airway stenosis or severe obstruction. Conclusion The antigenicity of tracheal allografts was significantly decreased by using the vitrified cryopreservation method, which would be a novel alternative method to store donor trachea to make tracheal banking possible.

Migration forces of transcatheter aortic valves in patients with noncalcific aortic insufficiency [Evolving Technology/Basic Science]

Objective Transcatheter aortic valves have been successfully implanted into the calcified leaflets of patients with severe aortic stenosis. However, their stability in patients with noncalcified aortic insufficiency is unknown. Similar to thoracic and abdominal aortic stent grafts, transcatheter aortic valves are subjected to antegrade ejection forces during systole. However, retrograde migration forces into the left ventricle are also generated by the diastolic pressure gradient across the closed valve. It has been suggested that leaflet calcification anchors the prosthesis, and measurements of migration forces should be considered before clinical trials in noncalcified aortic insufficiency. The objective of this study was to use computational fluid dynamics simulations to quantify forces that could potentially dislodge the prosthesis. Methods A computational fluid dynamics model was developed to simulate systolic flow through a geometric mesh of the aortic root and transcatheter aortic valves. Hemodynamic measurements were made at discrete moments during ejection. Unsteady control volume analysis was used for calculations of force on the mesh. Results Results of the simulation indicate that a total force of 0.602 N acts on the transcatheter aortic valves during systole, 99% of which is in the direction of axial flow. The largest contributor to force was the dynamic pressure gradient through the transcatheter aortic valves. This antegrade force is approximately 10 times smaller than the retrograde force (6.01 N) on the closed valve during diastole. Conclusion Our model simulated systolic flow through a transcatheter aortic valve and demonstrated migration into the left ventricle to be of greater concern than antegrade ejection.

Who is the high-risk recipient? Predicting mortality after lung transplantation using pretransplant risk factors [Cardiothoracic Transplantation]

Objectives The purpose of this study was to create a preoperative risk stratification score (RSS) based on pretransplant recipient characteristics that could be used to predict mortality following lung transplantation. Methods United Network for Organ Sharing provided deidentified patient-level data. The study population included 8780 adult recipients (age > 12 years) having lung transplantation from January 1, 1999, to December 31, 2006. Multivariate logistic regression (backward, P > .10) was performed. Using the odds ratio for each identified variable, an RSS was devised. The RSS included only pretransplant recipient variables and excluded donor variables. Results The strongest negative predictors of 1-year survival included extracorporeal membrane oxygenation, decreased estimated glomerular filtration rate, total bilirubin >2.0 mg/dL, recipient age, hospitalization at time of transplant, O2 dependence, cardiac index <2, steroid dependence, donor:recipient weight ratio <0.7, all non–cystic fibrosis/chronic obstructive pulmonary disease etiologies, and female donor–to–male recipient. Threshold analysis identified 4 discrete groups: low risk, moderate, elevated risk, and high risk. The 1-year actuarial survival was 80.4% for the entire group, compared with 56.8% in the high-risk group (RSS > 7.2, n = 490; 6%). Conclusion Pretransplant recipient variables significantly influence both early and late survival following lung transplantation. Some patients face a higher than average risk of mortality during their first year posttransplant, which challenges the goals of equitable organ allocation. RSS may improve organ allocation strategies by avoiding the potential negative impact of performing transplantation in extremely high-risk candidates.

The novel use of Nuss bars for reconstruction of a massive flail chest [Brief Technique Reports]

Near-fatal bleeding after transmyocardial ventricle lesion during removal of the pectus bar after the Nuss procedure [Brief Technique Reports]

V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma [Brief Technique Reports]

A novel method for reconstructing the sinus and annulus for the treatment of annuloaortic ectasia [Brief Technique Reports]

Right ventricular exclusion procedure for right ventricular failure of Ebstein's anomaly [Brief Technique Reports]

Use of moldable titanium bars and rib clips for total sternal replacement: A new composite technique [Brief Technique Reports]

Color Doppler ultrasonography in detecting transdiaphragmatic flow of hepatic hydrothorax: Correlation with thoracoscopic findings [Brief Research Report]

Increased perioperative mortality in elective coronary artery bypass grafting after previous percutaneous coronary intervention [Letters to the Editor]

Reply to the Editor [Letters to the Editor]

Aortic stenosis and statins [Letters to the Editor]

Reply to the Editor [Letters to the Editor]

Transcatheter heart valve optimal size [Letters to the Editor]

Highlights of the 2009 Society of Vascular Surgery annual meeting [Meeting Proceedings]

Cardiothoracic RSS : Gourt

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Thomas B. Ferguson, MD: Recipient, 2009 Lifetime Achievement Award American Association for Thoracic Surgery [Lifetime Achievement Award]

The quality conundrum [Presidential Address]

The STICH trial: Misguided conclusions [Expert Commentary]

Simulation in cardiothoracic surgery: A paradigm shift in education? [Editorial]

Is transapical aortic valve implantation really less invasive than minimally invasive aortic valve replacement? [Acquired Cardiovascular Disease]

Discussion [Acquired Cardiovascular Disease]

Survival after transapical and transfemoral aortic valve implantation: Talking about two different patient populations [Acquired Cardiovascular Disease]

Discussion [Acquired Cardiovascular Disease]

Selective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery [Acquired Cardiovascular Disease]

Discussion [Acquired Cardiovascular Disease]

Mitral annular hinge motion contribution to changes in mitral septal-lateral dimension and annular area [Acquired Cardiovascular Disease]

Discussion [Acquired Cardiovascular Disease]

Narrowing the gap: Early and intermediate outcomes after percutaneous coronary intervention and coronary artery bypass graft procedures in California, 1997 to 2006 [Acquired Cardiovascular Disease]

Discussion [Acquired Cardiovascular Disease]

Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? [Acquired Cardiovascular Disease]

Improved survival after coronary artery bypass grafting has not influenced the mortality disadvantage in patients with diabetes mellitus [Acquired Cardiovascular Disease]

Effects and mechanisms of left ventricular false tendons on functional mitral regurgitation in patients with severe cardiomyopathy [Acquired Cardiovascular Disease]

Endovascular treatment of acute traumatic thoracic aortic injuries: A retrospective analysis of 20 cases [Acquired Cardiovascular Disease]

An empirically based tool for analyzing mortality associated with congenital heart surgery [Congenital Heart Disease]

Improved management of systemic venous anomalies in a single ventricle: New rationale [Congenital Heart Disease]

The potential of disproportionate growth of tricuspid valve after decompression of the right ventricle in patients with pulmonary atresia and intact ventricular septa [Congenital Heart Disease]

Results of surgical repair of atrioventricular septal defect with double-orifice left atrioventricular valve [Congenital Heart Disease]

Preoperative lymphopenia is a predictor of postoperative adverse outcomes in children with congenital heart disease [Congenital Heart Disease]

Aggressive surgical treatment of multidrug-resistant tuberculosis [General Thoracic Surgery]

Discussion [General Thoracic Surgery]

Reconstruction of the pulmonary artery for lung cancer: Long-term results [General Thoracic Surgery]

Discussion [General Thoracic Surgery]

Elongation gastroplasty with transverse fundoplasty: The Jeyasingham repair [General Thoracic Surgery]

Reliability of positron emission tomography-computed tomography in identification of mediastinal lymph node status in patients with non-small cell lung cancer [General Thoracic Surgery]

Routine surgical videothoracoscopy as the first step of the planned resection for lung cancer [General Thoracic Surgery]

Warm-blood cardioplegic arrest induces selective mitochondrial translocation of protein kinase C{epsilon} followed by interaction with 6.1 inwardly rectifying potassium channel subunit in viable myocytes overexpressing urocortin [Evolving Technology/Basic Science]

Animal models of tracheal allotransplantation using vitrified cryopreservation [Evolving Technology/Basic Science]

Migration forces of transcatheter aortic valves in patients with noncalcific aortic insufficiency [Evolving Technology/Basic Science]

Who is the high-risk recipient? Predicting mortality after lung transplantation using pretransplant risk factors [Cardiothoracic Transplantation]

The novel use of Nuss bars for reconstruction of a massive flail chest [Brief Technique Reports]

Near-fatal bleeding after transmyocardial ventricle lesion during removal of the pectus bar after the Nuss procedure [Brief Technique Reports]

V-Y latissimus dorsi flap for coverage of anterior chest wall defects after resection of recurrent chest wall chondrosarcoma [Brief Technique Reports]

A novel method for reconstructing the sinus and annulus for the treatment of annuloaortic ectasia [Brief Technique Reports]

Right ventricular exclusion procedure for right ventricular failure of Ebstein's anomaly [Brief Technique Reports]

Use of moldable titanium bars and rib clips for total sternal replacement: A new composite technique [Brief Technique Reports]

Color Doppler ultrasonography in detecting transdiaphragmatic flow of hepatic hydrothorax: Correlation with thoracoscopic findings [Brief Research Report]

Increased perioperative mortality in elective coronary artery bypass grafting after previous percutaneous coronary intervention [Letters to the Editor]

Reply to the Editor [Letters to the Editor]

Aortic stenosis and statins [Letters to the Editor]

Reply to the Editor [Letters to the Editor]

Transcatheter heart valve optimal size [Letters to the Editor]

Highlights of the 2009 Society of Vascular Surgery annual meeting [Meeting Proceedings]

Meetings and Courses [Meetings and Courses]

AATS 90th Annual Meeting [Announcements]

Aortic Symposium 2010 [Announcements]

AATS Meetings and Sponsored Events [Announcements]

2010 AATS Academy Applications Now Available [Announcements]