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The Journal of Thoracic and... Jan 2022
Topics: Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Internship and Residency; Postoperative Complications; Preceptorship; Surgeons; Thoracic Surgery
PubMed: 33581903
DOI: 10.1016/j.jtcvs.2020.12.115 -
Brazilian Journal of Cardiovascular... Oct 2021Despite being one of the main vacation destinations in the world, health care in the Caribbean faces many difficulties. The challenges involved in these islands' medical... (Review)
Review
INTRODUCTION
Despite being one of the main vacation destinations in the world, health care in the Caribbean faces many difficulties. The challenges involved in these islands' medical care range from low-resource institutions to lack of specialized care. In the field of thoracic and cardiac surgery, many limitations exist, and these include the lack of access to cardiac surgery for many small islands and little governmental funding for minimally invasive approaches in thoracic surgery.
METHODS
Literature review was done using PubMed/MEDLINE and Google Scholar databases to identify articles describing the characteristics of thoracic and cardiac surgery departments on Caribbean islands. Articles on the history, current states of practice, and advances in cardiothoracic surgery in the Caribbean were reviewed.
RESULTS
Regardless of the middle to high-income profile of the Caribbean, there are significant differences in the speed of technological growth in cardiothoracic surgery from island to island, as well as disparities between the quality of care and resources. Many islands struggle to advance the field of cardiothoracic surgery both through lack of local cardiac surgery centers and limited financial funding for minimally invasive thoracic surgery.
CONCLUSIONS
Cardiac and thoracic surgery in the Caribbean depend not only on the support from local government policies and proper distribution of healthcare budgets, but efforts by the surgeons themselves to change and improve institutional cultures. Although resource availability still remains a challenge, the Caribbean remains an important region that deserves special attention with regard to the unmet needs for long-term sustainability of chest surgery.
Topics: Cardiac Surgical Procedures; Caribbean Region; Humans; Minimally Invasive Surgical Procedures; Surgeons; Thoracic Surgery
PubMed: 33577262
DOI: 10.21470/1678-9741-2020-0377 -
The Journal of Thoracic and... Jun 2017
Review
Topics: Anti-Infective Agents; Cardiac Surgical Procedures; Consensus; Endocarditis; Evidence-Based Medicine; Humans; Societies, Medical; Thoracic Surgery; Treatment Outcome
PubMed: 28365016
DOI: 10.1016/j.jtcvs.2016.09.093 -
The Journal of Thoracic and... May 2021
Topics: Cardiac Surgical Procedures; Career Choice; Clinical Competence; Education; Educational Measurement; Humans; Job Application; Personnel Selection; Thoracic Surgery
PubMed: 32199661
DOI: 10.1016/j.jtcvs.2020.02.074 -
The Journal of Thoracic and... Jun 2017
Topics: Cardiac Surgical Procedures; Diffusion of Innovation; History, 20th Century; History, 21st Century; Humans; Periodicals as Topic; Societies, Medical; Thoracic Surgery; Thoracic Surgical Procedures
PubMed: 28341470
DOI: 10.1016/j.jtcvs.2017.02.026 -
The Journal of Thoracic and... Jun 2021
Topics: Clinical Competence; Coronary Artery Bypass; Humans; Surgeons; Thoracic Surgery
PubMed: 32482407
DOI: 10.1016/j.jtcvs.2020.03.152 -
British Journal of Anaesthesia Oct 2017
Topics: Cardiac Surgical Procedures; Humans; Inflammation; Postoperative Complications; Risk Factors; Systemic Inflammatory Response Syndrome; Thoracic Surgery
PubMed: 29121304
DOI: 10.1093/bja/aex275 -
Interactive Cardiovascular and Thoracic... Oct 2022Training in congenital cardiac surgery is potentially lengthier and more demanding than training in any other surgical field. The duration of training is proportional to...
Training in congenital cardiac surgery is potentially lengthier and more demanding than training in any other surgical field. The duration of training is proportional to the complexity of the specialization. The expertise of a wide range of procedures is required. There is no doubt that some individuals may acquire the requisite abilities with greater ease than others, but fundamentally, these are capabilities that can be taught and learnt. Moreover, congenital cardiac surgeons are required to have a detailed understanding of pathophysiology and morphology, in addition to the stamina and empathy required to manage these complex patients. A fellowship is just the start of such training and is followed by a long road eventually leading to a lifelong journey to become a qualified congenital cardiac surgeon. Effective mentorship is a prerequisite throughout training to guide surgeons on this journey.
Topics: Humans; Heart Defects, Congenital; Surgeons; Cardiac Surgical Procedures; Thoracic Surgery; Data Collection
PubMed: 36260088
DOI: 10.1093/icvts/ivac250 -
The Journal of Thoracic and... Jan 2022Most of all congenital cardiac surgical programs participate in public outcomes reporting. The primary end point is transparency. In this era, academic programs with...
OBJECTIVE
Most of all congenital cardiac surgical programs participate in public outcomes reporting. The primary end point is transparency. In this era, academic programs with surgical residents face the challenge of producing outstanding results while allowing residents to learn by doing. We sought to understand the effect of education on our surgical outcomes.
METHODS
We collected data for all American Board of Thoracic Surgery index cases done at our institution over a 10-year period. We identified 3406 cases and categorized them into 2 groups according to primary surgeon: attending (2269) versus resident (1137). In a multivariable logistic regression model we examined the effect of operating surgeon on in-hospital mortality, major morbidity, and length of stay. We used propensity score matching subsequently to balance differences between cohorts, and multivariable logistic regression was repeated.
RESULTS
Using the entire cohort, multivariable logistic regression model adjusted for age, sex, weight, lack of preoperative comorbidity, presence of preoperative respiratory failure, The Society of Thoracic Surgeons--European Association for Cardio-Thoracic Surgery category, and need for deep hypothermic circulatory arrest, showed a higher odds of survival in the resident cohort (odds ratio, 1.484; 95% confidence interval, 0.998-2.206; P = .05). Propensity score matching identified 1137 pairs of attending and resident cases with well-balanced preoperative variables. Logistic regression modeling using the matched cohort showed equivalent 30-day mortality, 30-day major morbidity, and length of stay.
CONCLUSIONS
There was no difference in mortality, major morbidity, or length of stay when similar cases were compared that were operated on by attendings versus those by a resident. Effectively educating congenital heart surgeons without compromising an operation's quality requires thoughtful approach, including case selection and graded responsibility.
Topics: Cardiac Surgical Procedures; Clinical Competence; Heart Defects, Congenital; Hospital Mortality; Humans; Internship and Residency; Length of Stay; Outcome Assessment, Health Care; Patient Selection; Postoperative Complications; Preceptorship; Social Responsibility; Surgeons; Thoracic Surgery
PubMed: 33581904
DOI: 10.1016/j.jtcvs.2020.12.112 -
The Thoracic and Cardiovascular Surgeon Aug 2022Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac,...
Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2021 are analyzed. Under more than extraordinary conditions of the further ongoing worldwide coronavirus disease 2019 (COVID-19) pandemic, a total of 161,261 procedures were submitted to the registry. In total, 92,838 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 27,947 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.2:1) was 97.3%. For the 36,714 isolated heart valve procedures (19,242 transcatheter interventions included) it was 96.7 and 99.0% for the registered pacemaker and International Classification of Diseases (ICD) procedures (19,490), respectively. Concerning short- and long-term circulatory support, a total of 3,404 ECLS/ECMO implantations and 750 assist device implantations (L-/ R-/ BVAD, TAH), respectively were registered. In 2021 329 isolated heart transplantations, 254 isolated lung transplantations, and one combined heart-lung transplantations were performed.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.
Topics: COVID-19; Cardiac Surgical Procedures; Germany; Hospital Mortality; Humans; Quality Indicators, Health Care; Registries; Societies, Medical; Thoracic Surgery; Time Factors; Treatment Outcome
PubMed: 35948014
DOI: 10.1055/s-0042-1754353