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Liu S, Ma J, Gao J, Zhang L, Liu W, Lin D, Yang Z. Risk Factors and Early Outcomes for Gastrointestinal Complications in Patients Undergoing Open Surgery for Type A Aortic Dissection. Am Surg 2023; 89:5450-5458. [PMID: 36788032 DOI: 10.1177/00031348231156768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Gastrointestinal complications need to be paid more attention, especially in critically ill patients. The purpose of this study was to identify the risk factors and short-term outcomes of gastrointestinal complications after open surgery for type A aortic dissection. METHODS A retrospective single-institutional study including patients who underwent open surgery for type A aortic dissection during 2012-2020 was conducted. Univariate analysis and logistic regression analysis were used to identify risk factors associated with gastrointestinal complications. The related clinical outcomes were compared between the patients with and without gastrointestinal complications. RESULTS Among the 2746 patients, 150 developed gastrointestinal complications. The development of gastrointestinal complications contributed to the higher rate of mortality (P = .008), longer stay in the intensive care unit (P < .001), and longer hospital stay (P < .001). Logistic regression analysis showed that age (odds ratio [OR] 1.020; 95% confidence interval [CI] 1.005-1.057; P = .011), American Society of Anesthesiologists classification greater than grade III (OR 1.724; 95%CI 1.179-2.521, P = .005), pre-induction mean arterial pressure (OR 0.978; 95%CI 0.965-0.990, P = .001), aortic cross-clamp time (OR 1.012; 95%CI 1.005-1.019, P = .001), cardiopulmonary bypass time (OR 1.007; 95%CI 1.002-1.011, P = .002), and intraoperative transfusion of red blood cells (OR 1.214; 95%CI 1.122-1.314, P = .001) were independent risk factors for gastrointestinal complications. CONCLUSIONS The incidence of gastrointestinal complications after open surgery for type A aortic dissection was 5.5%, resulting in increased mortality and prolonged hospital stay. It is necessary to take suitable strategies to reduce the incidence of gastrointestinal complications.
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Affiliation(s)
- Shuo Liu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, People's Republic of China
| | - Jun Ma
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Junwei Gao
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Liang Zhang
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wenjun Liu
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Duomao Lin
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhanmin Yang
- Department of Anesthesiology, Aerospace Center Hospital, Beijing, People's Republic of China
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An Z, Zhong K, Sun Y, Han L, Xu Z, Li B. Risk factors for in-hospital mortality after total arch procedure in patients with acute type A aortic dissection. Front Cardiovasc Med 2023; 10:1149907. [PMID: 37180796 PMCID: PMC10167004 DOI: 10.3389/fcvm.2023.1149907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023] Open
Abstract
Object Knowledge about the risk factors of in-hospital mortality for acute type A aortic dissection (ATAAD) patients who received total arch procedure is limited. This study aims to investigate preoperative and intraoperative risk factors of in-hospital mortality of these patients. Methods From May 2014 to June 2018, 372 ATAAD patients received the total arch procedure in our institution. These patients were divided into survival and death groups, and patients` in-hospital data were retrospectively collected. Receiver operating characteristic curve analysis was adopted to determine the optimal cut-off value of continuous variables. Univariate and multivariable logistic regression analyses were used to detect independent risk factors for in-hospital mortality. Results A total of 321 patients were included in the survival group and 51 in the death group. Preoperative details showed that patients in the death group were older (55.4 ± 11.7 vs. 49.3 ± 12.6, P = 0.001), had more renal dysfunction (29.4% vs. 10.9%, P = 0.001) and coronary ostia dissection (29.4% vs. 12.2%, P = 0.001), and decreased left ventricular ejection fraction (LVEF) (57.5 ± 7.9% vs. 59.8 ± 7.3%, P = 0.032). Intraoperative results showed that more patients in the death group experienced concomitant coronary artery bypass grafting (35.3% vs. 15.3%, P = 0.001) with increased cardiopulmonary bypass (CPB) time (165.7 ± 39.0 vs. 149.4 ± 35.8 min, P = 0.003), cross-clamp time (98.4 ± 24.5 vs. 90.2 ± 26.9 min, P = 0.044), and red blood cell transfusion (913.7 ± 629.0 vs. 709.7 ± 686.6 ml, P = 0.047). Logistic regression analysis showed that age >55 years, renal dysfunction, CPB time >144 min, and RBC transfusion >1,300 ml were independent risk factors for in-hospital mortality in patients with ATAAD. Conclusion In the present study, we identified that older age, preoperative renal dysfunction, long CPB time, and intraoperative massive transfusion were risk factors for in-hospital mortality in ATAAD patients with the total arch procedure.
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Affiliation(s)
- Zhao An
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Keng Zhong
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yangyong Sun
- Department of Cardiothoracic Surgery, Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bailing Li
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
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Ding X, Sun B, Liu L, Lei Y, Su Y. Nomogram and Risk Calculator for Postoperative Tracheostomy after Heart Valve Surgery. J Cardiovasc Dev Dis 2023; 10:73. [PMID: 36826569 PMCID: PMC9967351 DOI: 10.3390/jcdd10020073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Postoperative tracheostomy (POT) is an important indicator of critical illness, associated with poorer prognoses and increased medical burdens. However, studies on POTs after heart valve surgery (HVS) have not been reported. The objectives of this study were first to identify the risk factors and develop a risk prediction model for POTs after HVS, and second to clarify the relationship between POTs and clinical outcomes. Consecutive adults undergoing HVS from January 2016 to December 2019 in a single cardiovascular center were enrolled, and a POT was performed in 1.8% of the included patients (68/3853). Compared to patients without POTs, the patients with POTs had higher rates of readmission to the ICU and in-hospital mortality, as well as longer ICU and hospital stays. Five factors were identified to be significantly associated with POTs after HVS by our multivariate analysis, including age, diabetes mellitus, pulmonary edema, intraoperative transfusion of red blood cells, and surgical types. A nomogram and a risk calculator were constructed based on the five factors, showing excellent discrimination, calibration, and clinical utility. Three risk intervals were defined as low-, medium-, and high-risk groups according to the nomogram and clinical practice. The findings of this study may be helpful for early risk assessment and perioperative management.
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Affiliation(s)
- Xiangchao Ding
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan 430064, China
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Bing Sun
- Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan 430064, China
| | - Liang Liu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Yuan Lei
- Department of Gerontology, Renmin Hospital of Wuhan University, Wuhan 430064, China
| | - Yunshu Su
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan 430064, China
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Wang L, Zhong G, Lv X, Dong Y, Hou Y, Dai X, Chen L. Risk factors for acute kidney injury after Stanford type A aortic dissection repair surgery: a systematic review and meta-analysis. Ren Fail 2022; 44:1462-1476. [PMID: 36036431 PMCID: PMC9427034 DOI: 10.1080/0886022x.2022.2113795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Risk factors for acute kidney injury (AKI) after Stanford type A aortic dissection (TAAD) repair are inconsistent in different studies. This meta-analysis systematically analyzed the risk factors so as to early identify the therapeutic targets for preventing AKI. Methods: Studies exploring risk factors for AKI after TAAD repair were searched from four databases from inception to June 2022. The synthesized incidence and risk factors of AKI and its impact on mortality were calculated. Results: Twenty studies comprising 8223 patients were included. The synthesized incidence of postoperative AKI was 50.7%. Risk factors for AKI included cardiopulmonary bypass (CPB) time >180 min [odds ratio (OR), 4.89, 95% confidence interval (CI), 2.06–11.61, I2 = 0%], prolonged operative time (>7 h) (OR, 2.73, 95% CI, 1.95–3.82, I2 = 0), advanced age (per 10 years) (OR, 1.34, 95% CI, 1.21–1.49, I2 = 0], increased packed red blood cells (pRBCs) transfusion perioperatively (OR, 1.09, 95% CI, 1.07–1.11, I2 = 42%), elevated body mass index (per 5 kg/m2) (OR, 1.23, 95% CI, 1.18–1.28, I2 = 42%) and preoperative kidney injury (OR, 3.61, 95% CI, 2.48–5.28, I2 = 45%). All results were meta-analyzed using fixed-effects model finally (p < 0.01). The in-hospital or 30-day mortality was higher in patients with postoperative AKI than in that without AKI [risk ratio (RR), 3.12, 95% CI, 2.54–3.85, p < 0.01]. Conclusions: AKI after TAAD repair increased the in-hospital or 30-day mortality. Reducing CPB time and pRBCs transfusion, especially in elderly or heavier weight patients, or patients with preoperative kidney injury were important to prevent AKI after TAAD repair surgery.
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Affiliation(s)
- Lei Wang
- Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Guodong Zhong
- Department of Pathology, the Second People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaochai Lv
- Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Yi Dong
- Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Yanting Hou
- Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Xiaofu Dai
- Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital of Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, China
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Hemli JM, Ducca EL, Chaplin WF, Arader LL, Scheinerman SJ, Lesser ML, Ahn S, Mihelis EA, Jahn LA, Patel NC, Brinster DR. Transfusion in Root Replacement for Aortic Dissection: STS Adult Cardiac Surgery Database Analysis. Ann Thorac Surg 2022; 114:2149-2156. [PMID: 35452664 DOI: 10.1016/j.athoracsur.2022.03.068] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 03/22/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Transfusion in acute aortic syndromes has been studied in a limited fashion. We sought to describe contemporary transfusion practice for root replacement in acute (Stanford) type A aortic dissection (ATAAD). METHODS The STS Adult Cardiac Surgery Database was interrogated to identify patients who underwent primary aortic root replacement for ATAAD (July 2014 - June 2017). Patients (n = 1558) were stratified by type of root replacement. Multivariate regression was used to determine those variables associated with transfusion and postoperative morbidity. RESULTS Transfusion was required in 90.5% of cases (n = 1410). Operative mortality for all patients was 17.3% (261 deaths). Intraoperative red blood cell (RBC) transfusion portended reduced short-term survival (odds ratio {OR} 2.00, p = 0.025). Massive postoperative transfusion was associated with prolonged ventilation (OR 13.47, p < 0.001), sepsis (OR 4.13, p < 0.001), and new dialysis-dependent renal-failure (OR 2.43, p < 0.001). Females were more likely to require transfusion (OR 3.03, p < 0.001), as were patients who had coronary bypass (OR 1.57, p = 0.009), and those in shock (OR 2.27, p < 0.001). Valve-sparing aortic root replacement (VSARR) was associated with reduced transfusion requirements vs. composite roots. Institutional case volume was not appreciably correlated with transfusion. CONCLUSIONS Most patients undergoing root replacement for aortic dissection require blood products. Composite root replacement is associated with a greater likelihood of transfusion than a valve-sparing operation. Transfusion independently foreshadows greater operative mortality.
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Affiliation(s)
- Jonathan M Hemli
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA.
| | - Emma L Ducca
- Department of Psychology, St John's University, Queens, NY, USA
| | | | | | - S Jacob Scheinerman
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Martin L Lesser
- Biostatistics Unit, Feinstein Institutes for Medical Research / Northwell Health, Great Neck, NY, USA
| | - Seungjun Ahn
- Biostatistics Unit, Feinstein Institutes for Medical Research / Northwell Health, Great Neck, NY, USA
| | - Efstathia A Mihelis
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Lynda A Jahn
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Nirav C Patel
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
| | - Derek R Brinster
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA
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Predictors and outcomes of postoperative tracheostomy in patients undergoing acute type A aortic dissection surgery. BMC Cardiovasc Disord 2022; 22:94. [PMID: 35264113 PMCID: PMC8908588 DOI: 10.1186/s12872-022-02538-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background Despite surgical advances, acute type A aortic dissection remains a life-threatening disease with high mortality and morbidity. Tracheostomy is usually used for patients who need prolonged mechanical ventilation in the intensive care unit (ICU). However, data on the risk factors for requiring tracheostomy and the impact of tracheostomy on outcomes in patients after Stanford type A acute aortic dissection surgery (AADS) are limited. Methods A retrospective single-institutional study including consecutive patients who underwent AADS between January 2016 and December 2019 was conducted. Patients who died intraoperatively were excluded. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for postoperative tracheostomy (POT). A nomogram to predict the probability of POT was constructed based on independent predictors and their beta-coefficients. The area under the receiver operating characteristic curve (AUC) was performed to assess the discrimination of the model. Calibration plots and the Hosmer–Lemeshow test were used to evaluate calibration. Clinical usefulness of the nomogram was assessed by decision curve analysis. Propensity score matching analysis was used to analyze the correlation between requiring tracheostomy and clinical prognosis. Results There were 492 patients included in this study for analysis, including 55 patients (11.2%) requiring tracheostomy after AADS. Compared with patients without POT, patients with POT experienced longer ICU and hospital stay and higher mortality. Age, cerebrovascular disease history, preoperative white blood cell (WBC) count and renal insufficiency, intraoperative amount of red blood cell (RBC) transfusion and platelet transfusion were identified as independent risk factors for POT. Our constructed nomogram had good discrimination with an AUC = 0.793 (0.729–0.856). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. For better clinical application, we defined four intervals that stratified patients from very low to high risk for occurrence of POT. Conclusions Our study identified preoperative and intraoperative risk factors for POT and found that requiring tracheostomy was related to the poor outcomes in patients undergoing AADS. The established prediction model was validated with well predictive performance and clinical utility, and it may be useful for individual risk assessment and early clinical decision-making to reduce the incidence of tracheostomy.
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7
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Sorber R, Bowen CJ, Hicks CW, Black JH. Connective tissue disease type mediates branch patency of grafts in open thoracoabdominal aortic reconstruction. J Vasc Surg 2022; 75:90-98. [PMID: 34186165 PMCID: PMC8710179 DOI: 10.1016/j.jvs.2021.05.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/24/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Despite a shared degenerative vascular phenotype, Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS), and other genetically distinct connective tissue diseases (CTDs) have unique extravascular pathologies that impact the outcomes of aortic replacement. The aim of our study was to investigate the association of CTD genotype with postoperative outcomes and branch patency following open thoracoabdominal aortic replacement in a large institutional cohort. METHODS All patients undergoing open branched thoracoabdominal aortic replacement at a single academic center from 2006 to 2020 were included and classified as CTD or non-CTD based on the presence of genotypic documentation. Outcomes were compared using analysis of variance and χ2 testing for continuous and discrete variables, respectively. Kaplan-Meier curves were utilized to examine patency of graft branches over time. RESULTS Overall, 172 patients were included, with a mean follow-up of 30.5 ± 34.9 months. CTD was present in 45 patients (26%); specifically, 32 had MFS, five had LDS, and eight had another CTD. Patients with CTDs had more extent II thoracoabdominal aneurysms (40% vs 15%), more reconstructed branches (3.5 vs 1.8), more frequently reconstructed visceral branches (86.7% vs 22.7%), and higher intraoperative blood loss (13.3 vs 6.8 L; all P < .05) compared with non-CTD patients. Patients with MFS were more frequently systemically anticoagulated preoperatively (50% vs 5%) and demonstrated higher rates of postoperative deep vein thrombosis/pulmonary embolism compared with non-CTD patients (9% vs 2%; both P < .05). Five-year renal branch patency was decreased among all patients compared with visceral branches (87.3% vs 95.6%; P = .05), but there were no individual branch patency differences between patients with and without CTDs (P = .086). Overall branch patency at 1 and 5 years was significantly higher in patients with MFS than in non-CTD patients (98.9% vs 89.1% at 5 years); there were no significant patency differences between non-CTD patients and any other CTD subgroup, mostly due to early patency loss. CONCLUSIONS Open thoracoabdominal reconstruction in patients with CTD is technically challenging and associated with increased transfusion and postoperative thromboembolic events when compared with non-CTD patients. Technical outcomes of the procedure are excellent and are differentially associated with genotype, with patients with MFS experiencing significantly improved branch patency over both non-CTD patients and patients with other CTDs, a finding which has multifactorial drivers.
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Affiliation(s)
- Rebecca Sorber
- Department of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital,Department of Genetic Medicine, Johns Hopkins University School of Medicine
| | - Caitlin J. Bowen
- Department of Genetic Medicine, Johns Hopkins University School of Medicine
| | - Caitlin W. Hicks
- Department of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital,Johns Hopkins Surgery Center For Outcomes Research (JSCOR),Johns Hopkins University School of Medicine
| | - James H. Black
- Department of Vascular Surgery and Endovascular Therapy, The Johns Hopkins Hospital
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Beliaev AM, Henry L, Bergin C, Willcox T, Sibal AK. Impact of effective communication on acute type A aortic dissection management of a Jehovah's Witness patient. ANZ J Surg 2019; 89:1683. [PMID: 31846564 DOI: 10.1111/ans.15505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 09/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Andrei M Beliaev
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Luke Henry
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Colleen Bergin
- Anatomy with Medical Imaging, FHMS University of Auckland, Auckland, New Zealand
| | - Tim Willcox
- Department of Anaesthesiology, FHMS University of Auckland, Auckland, New Zealand
| | - Amul K Sibal
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
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