Competence by Design in Cardiac Surgery Resident Training: A Qualitative Thematic Analysis.

Introduction: A new training model known as "Competence by Design" (CBD) is centered on evaluating "entrustable professional activities" and "milestones" and it represents a paradigm change from time-based to outcome-based learning and evaluation. This study presents a qualitative quality assurance and improvement assessment of the current state of CBD in cardiac surgery training at a single center.

Methods: An initial questionnaire was distributed to three focus groups: educators, traditional-system trainees, and CBD trainees.

Technique for Adaptation of Konno Aortoventriculoplasty in Patient-Prosthesis Mismatch.

The patient-prosthesis mismatch has been reported as an important cause of adverse outcome following aortic valve replacement. The relief of patient-prosthesis mismatch generally requires a reoperation of comprehensive nature, which necessitates an extensive aortic root enlargement. The Konno aortoventriculoplasty represents an efficient treatment option, as this technique provides both extreme root enlargement and relief of the frequently associated subvalvular obstruction.

Rerouting anomalous coronary artery origin in aortopulmonary window in newborn.

Coronary artery anomalies may accompany the aortopulmonary window and, if not noticed, may cause catastrophic consequences. The repair of the aortopulmonary window is quite straightforward; however, establishing a normal coronary pattern may challenge the repair. When the anomalous origin of the coronary artery is on the defect rim, right at the location where sutures are to be placed, it may interfere with proper suture placement.

Recommendations for Valve Replacement in Ischemic Mitral Regurgitation with Compromised Ventricle.

The unique features of ischemic mitral regurgitation may necessitate attention to certain points during mitral valve replacement (MVR). A few simple but practical recommendations are offered for concomitant or isolated MVR in this high-risk population which is often burdened by an extremely limited myocardial reserve.

Mitral Patient-Prosthesis Mismatch Predicts Suboptimal Hemodynamic Recovery after Mitral Valve Replacement.

Background: A possible relationship between an obstructive prosthesis and suboptimal hemodynamic recovery, as reflected by unsatisfactory regression in systolic pulmonary artery pressure (sPAP) and functional tricuspid regurgitation (FTR) following mitral valve replacement (MVR), was investigated. A delineating effective orifice area index (EOAI) value was sought in order to define a patient-prosthesis mismatch.

Methods: A total of 128 patients undergoing isolated mechanical MVR were followed up for a mean of 46 ± 9 months.

Aortoventriculoplasty for correction of patient-prosthesis mismatch examples.

Objective: Patient-prosthesis mismatch is often considered as an important cause of adverse outcome following aortic valve replacement. A small annulus represents a challenge for the surgeon; yet can be best managed at the initial operation using relatively simple techniques, as later-on correction is often far more challenging. Corrective reoperations necessitate drastic root enlargement, along with the relief of subvalvular muscular obstruction.

Remote Targets for Right Coronary Artery Bypass: Distal Trunk or Posterior Descending Artery Grafting.

Background: Choosing a good anastomotic site is crucial during surgical revascularization of the right coronary artery (RCA) system. In many instances of distal and/or sequential main trunk disease, either the right posterior descending coronary artery (RPDA) or distal part of the right main coronary artery (DRCA) is preferred as the target vessel. In this article, the saphenous vein graft (SVG) patency is compared between these two main targets in the long term.

Visceral protection during moderately hypothermic selective antegrade cerebral perfusion through right brachial artery.

Objective: This study investigates distal organ protection during moderately hypothermic right brachial artery selective antegrade cerebral perfusion (MHSACP) in patients undergoing aortic arch repair.

Methods: Fifty patients undergoing ascending aorta/aortic arch repair using the MHSACP technique (study group) were compared with another 50 patients randomly selected amongst those undergoing moderately hypothermic open heart procedures (control group). The data from successive clinical examinations and blood samplings were then compared to detect any sign of distal organ damage attributable to the MHSACP technique.

Ventricular assist device applications.

Since the commencement of the artificial-heart program at the National Institutes of Health in 1964, many circulatory-support devices have been developed for short-term use in patients with end-stage heart failure. In the last decade, the interest on mechanical devices for ventricular assistance increased rapidly. As a result, significant advances in both the technology and clinical experience in the field of mechanical cardiac assist occurred over the last decade.

What to expect after tricuspid valve replacement? Long-term results.

Objective: Current knowledge in long-term results of tricuspid valve replacement is limited. Present study reviews our experience from a consecutive series.

Methods: Forty-two patients (16 male, 26 female; mean age: 33+/-15) underwent tricuspid valve replacement between March 1987 and December 2004.

Cardiac surgery during pregnancy.

Background And Aim Of The Study: Cardiac surgery during pregnancy represents a major challenge as it comprises a single operation for two survivors.

Methods: Between 1988 and 2005, 16 pregnant women underwent cardiac surgery at the authors' institution. Among 14 patients with rheumatic mitral stenosis operated on due to clinical deterioration, closed mitral valvulotomy was performed in 12 cases (three urgently in the third trimester, nine at term concomitantly with cesarean delivery).

Acute renal failure following open heart surgery: risk factors and prognosis.

Background: Acute renal failure (ARF) development after cardiac surgery carries high mortality and morbidity.

Methods: Out of 14437 consecutive patients undergoing open-heart surgery between January 1991 and May 2001, 168 (1.16%) developed postoperative ARF mandating hemodialysis.

Does delayed correction interfere with pulmonary functions and exercise tolerance in patients with tetralogy of fallot?

Study Objectives: To assess exercise tolerance and determine the distinct role of cardiac, respiratory, or peripheral factors on it after delayed surgical repair in patients with tetralogy of Fallot.

Design: The aerobic exercise capacity of 15 adult patients (mean [+/- SD] age, 21 +/- 6; age range, 9 to 30 years) undergoing successful total correction at a mean age of 12 +/- 5 years (patients) was compared to healthy, matched control subjects by using right ventricle echocardiography, resting spirometry, and cardiopulmonary exercise tests at a mean postoperative time of 7.5 +/- 4.

Off-pump, in situ internal thoracic artery grafting: a durable treatment for single-vessel coronary artery disease.

Background: The value of off-pump in situ left internal thoracic artery to left anterior descending coronary artery bypass grafting in single-vessel coronary artery disease was assessed by long-term angiographic and clinical data.

Methods: One-hundred three randomly selected patients (87 male, 16 female; mean age, 57.4 +/- 10.

Off-pump coronary artery bypass grafting: long term angiographic results.

Objective: Although short-term results of off-pump coronary artery bypass grafting are well documented, late postoperative data are still scarce. This report provides an analysis of late postoperative control angiograms.

Methods: 265 patients (231 males, 34 females; mean age: 54 +/- 10) underwent postoperative angiographic control, after an average postoperative period of 4.

Compelling nature of arterial manifestations in Behcet disease.

Introduction: We present our experience with surgical treatment of arterial complications in Behcet disease (vasculo-Behcet disease), and the long-term results and pitfalls of surgical treatment.

Material And Methods: Between January 1990 and January 2003, 20 consecutive patients underwent surgery to treat vasculo-Behcet disease. Most patients (17 of 20) were men, with mean age of 38.