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Gerstl JVE, Gupta S, Stenberg CE, Chabros J, Nonnenbroich LF, Lindberg R, Altshuler MS, Seaver D, Mooney MA, Frerichs KU, Smith TR, Arnaout O. From Operating Room to Courtroom: Analyzing Malpractice Trajectories in Cranial Neurosurgery. Neurosurgery 2024:00006123-990000000-01237. [PMID: 38916340 DOI: 10.1227/neu.0000000000003052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/26/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Nearly all neurosurgeons in the United States will be named defendants in a malpractice claim before retirement. We perform an assessment of national malpractice trends in cranial neurosurgery to inform neurosurgeons on current outcomes, trends over time, benchmarks for malpractice coverage needs, and ways to mitigate lawsuits. METHODS The Westlaw Edge and LexisNexis databases were searched to identify medical malpractice cases relating to open cranial surgery between 1987 and 2023. Extracted data included date of verdict, jurisdiction, outcome, details of sustained injuries, and any associated award/settlement figures. RESULTS Of 1550 cases analyzed, 252 were identified as malpractice claims arising from open cranial surgery. The median settlement amount was $950 000 and the average plaintiff ruling was $2 750 000. The highest plaintiff ruling resulted in an award of $28.1 million. Linear regression revealed no significant relationship between year and defendant win (P-value = .43). After adjusting for inflation, award value increased with time (P-value = .01). The most common cranial subspecialties were tumor (67 cases, 26.6%), vascular (54 cases, 21.4%), infection (23 cases, 9.1%), and trauma (23 cases, 9.1%). Perioperative complications was the most common litigation category (96 cases, 38.1%), followed by delayed treatment (40 cases, 15.9%), failure to diagnose (38 cases, 15.1%), and incorrect choice of procedure (29 cases, 11.5%). The states with most claims were New York (40 cases, 15.9%), California (24 cases, 9.5%), Florida (21 cases, 8.3%), and Pennsylvania (20 cases, 7.9%). CONCLUSION Although a stable number of cases were won by neurosurgeons, an increase in award sizes was observed in the 37-year period assessed. Perioperative complications and delayed treatment/diagnosis were key drivers of malpractice claims.
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Affiliation(s)
- Jakob V E Gerstl
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Program for Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jeremy Chabros
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Rebecca Lindberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marcelle S Altshuler
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David Seaver
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy R Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zhuoqun W, Zhiling T, Lei W, Hewen D, Donghua Z, Jianhua Z, Ningguo L. Application of postmortem computed tomography angiography to settle a medical dispute after aortic dissection surgery: a forensic case report. J Cardiothorac Surg 2023; 18:246. [PMID: 37596679 PMCID: PMC10439614 DOI: 10.1186/s13019-023-02353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND In the present case, we applied postmortem computed tomography angiography (PMCTA) in a medical dispute involving sudden death after cardiovascular surgery. CASE PRESENTATION A 39-year-old man underwent aortic arch replacement combined with stented elephant trunk implantation surgery under extracorporeal circulation. All vital signs were stable and he was arranged for discharge seven days after surgery. Several days later, the patient was sent back to the hospital for chest pain and poor appetite. Unfortunately, his condition worsened and he ultimately died. PMCT scanning detect pericardial effusion. Family members suspected that the surgical sutures were not dense enough, causing the patient's postoperative bleeding and resulting in cardiac tamponade and death. PMCTA was performed before autopsy, which showed pericardial effusion. However, postmortem angiography with simulated blood pressure showed no leakage of contrast agent, which guided the subsequent autopsy and histological examinations. CONCLUSIONS While many previous postmortem imaging case reports have shown positive results that provided evidence of medical malpractice, the current case excludes the possibility of physician negligence and reasonably settles the medical dispute from another perspective. In short, the PMCTA approach we describe here was an effective tool that can be applied to certain medical-related forensic cases.
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Grants
- 2022YFC3302002 National Key Research and Development Program of China
- 2022YFC3302002 National Key Research and Development Program of China
- 2022YFC3302002 National Key Research and Development Program of China
- 2022YFC3302002 National Key Research and Development Program of China
- 2022YFC3302002 National Key Research and Development Program of China
- 2022YFC3302002 National Key Research and Development Program of China
- 2022YFC3302002 National Key Research and Development Program of China
- 82171872 Council of National Science Foundation of China
- 82171872 Council of National Science Foundation of China
- 82171872 Council of National Science Foundation of China
- 82171872 Council of National Science Foundation of China
- 82171872 Council of National Science Foundation of China
- 82171872 Council of National Science Foundation of China
- 82171872 Council of National Science Foundation of China
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21ZR1464600 Council of National Science Foundation of Shanghai
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 21DZ2270800 Key Laboratory of judicial expertise of Ministry of Justice and Shanghai Key Laboratory of Forensic Medicine
- 19DZ2292700 Shanghai Forensic Service Platform
- 19DZ2292700 Shanghai Forensic Service Platform
- 19DZ2292700 Shanghai Forensic Service Platform
- 19DZ2292700 Shanghai Forensic Service Platform
- 19DZ2292700 Shanghai Forensic Service Platform
- 19DZ2292700 Shanghai Forensic Service Platform
- 19DZ2292700 Shanghai Forensic Service Platform
- 2020Z‑4 Central Research Institute Public Project
- 2020Z‑4 Central Research Institute Public Project
- 2020Z‑4 Central Research Institute Public Project
- 2020Z‑4 Central Research Institute Public Project
- 2020Z‑4 Central Research Institute Public Project
- 2020Z‑4 Central Research Institute Public Project
- 2020Z‑4 Central Research Institute Public Project
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
- KF202120 Shanghai Key Laboratory of Forensic Medicine, Key Lab of Forensic Science, Ministry of Justice
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Affiliation(s)
- Wang Zhuoqun
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
- School of Basic Medical Sciences, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Tian Zhiling
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Wan Lei
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Dong Hewen
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Zou Donghua
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Zhang Jianhua
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China
| | - Liu Ningguo
- Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Service Platform, Academy of Forensic Science, Ministry of Justice, Shanghai, People's Republic of China.
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Sen I, Choudhry A, Cherukuri SK, Mendes BC, Colglazier JJ, Shuja F, DeMartino RR, Rasmussen TE, Kalra M. An Analysis of Malpractice Litigation of Vascular Surgeons in Cases Involving Aortic Pathologies. Vasc Endovascular Surg 2023; 57:350-356. [PMID: 36537051 DOI: 10.1177/15385744221146389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The aim of this study was to analyze malpractice claims for aortic pathologies and to assess if there has been a change in rate of malpractice lawsuits with evolution of endovascular therapy. METHODS Malpractice lawsuits were individually screened and compiled from the Westlaw database from 2000 to 2017 through use of relevant search terms. Data were collected of allegations, diagnoses, and outcomes of each case and compared. RESULTS 268 unique cases were included in this study, with aneurysms (54%, n = 145) and dissection (35%, n = 94) making up the majority. There was a defendant verdict in 53% (n = 141), plaintiff verdict in 24% (n = 65), and settlements in 23% (n = 62) of lawsuits. Litigation was higher in the Midwest and Northeast. There was a gradual decline in litigation overall, however endovascular case numbers remained constant. There was negligible difference in the primary allegation underlying the litigation for various aortic pathologies, time to litigation and award between open and endovascular procedures. CONCLUSION The proportion of litigation for clinical negligence in endovascular cases amongst all vascular surgical lawsuits is increasing. As novel methods of endovascular therapy emerge, it is imperative that physicians remain vigilant to legal considerations to minimize malpractice risk.
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Affiliation(s)
- Indrani Sen
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Asad Choudhry
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sai Kiran Cherukuri
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bernardo C Mendes
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jill J Colglazier
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Fahad Shuja
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Randall R DeMartino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Todd E Rasmussen
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Manju Kalra
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Chen J, Zhang T, Feng D, Liu Y, Zhang T, Wang J, Liu L. A 9-year analysis of medical malpractice litigations in coronary artery bypass grafting in China. J Cardiothorac Surg 2023; 18:73. [PMID: 36782245 PMCID: PMC9926683 DOI: 10.1186/s13019-023-02172-x] [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: 09/10/2022] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The coronary artery bypass grafting (CABG) is one of the high-risk litigated medical specialties. Further elucidating the causes behind these malpractice claims can help physicians avoid patient injury. This study analyzed CABG litigations occurred in different level hospitals to outline the basic characteristics, as well as present a analysis on the medical malpractice that result in lawsuits. METHODS This study utilized the "China Judgments Online" database to compile litigations from 2012 to 2021 across China. 109 cases related to the CABG were included in the study, and were analyzed for demographic, patient outcomes and verdict characteristics in different levels of hospitals. RESULTS The median age of plaintiff patient was 62 years, the median length of stay was 25 days, and the median responsibility ratio of the litigation cases was 30%. The average proportion of responsibility of national, provincial and municipal hospitals were 29.6%, 28.4% and 39.5% respectively, and the median days after surgery to death of that were 15, 9 and 5 separately. The top 5 postoperative complications in dispute cases were: low cardiac output syndrome, postoperative hemorrhage, non-surgical site infections, surgical site infections and arrhythmia. CONCLUSIONS The diagnosis and treatment capabilities of coronary artery bypass grafting in different levels of hospitals in China were inconsistent, and the treatment capabilities in prefecture-level hospitals were lower than that in national hospitals. The procedural error, failure to properly monitor the patient and diagnostic errors were common in CABG litigations. Postoperative complications related to surgical injuries and insufficient basic postoperative management lead to a higher responsibility proportion.
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Affiliation(s)
- Jie Chen
- grid.488137.10000 0001 2267 2324Medical School of Chinese People’s Liberation Army, Beijing, China ,grid.411634.50000 0004 0632 4559Department of Medical Quality Management, Peking University People’s Hospital, Beijing, China
| | - Tianyi Zhang
- grid.414252.40000 0004 1761 8894Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Dan Feng
- grid.414252.40000 0004 1761 8894Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Yuehui Liu
- grid.414252.40000 0004 1761 8894Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Tao Zhang
- grid.411634.50000 0004 0632 4559Department of Vascular Surgery, Peking University People’s Hospital, Beijing, China
| | - Jingtong Wang
- Department of Medical Quality Management, Peking University People's Hospital, Beijing, China.
| | - Lihua Liu
- Institution of Hospital Management, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China.
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Palaniappan A, Sellke FW. Medical malpractice in aortic valve and mitral valve replacement surgery in North America. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:106-113. [PMID: 34338496 DOI: 10.23736/s0021-9509.21.11945-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic and mitral valve replacement are commonly performed by cardiovascular surgeons, but little data quantitatively analyzes the etiology and prevalence of medical malpractice litigations involving these operations. This study aims to analyze incidence, cause, and resolution of medical malpractice lawsuits involving aortic and mitral valve replacements, alone and in combination with coronary artery bypass and/or aortic procedures. METHODS The Westlaw legal database was utilized to compile relevant litigations across the United States from 1994-2019. Clinical data, verdict data, demographic data, and litigation attributes were compiled. Fisher-exact tests and Mann-Whitney tests were performed for statistical analyses. RESULTS One hundred four malpractice litigations involving aortic valve replacement and 55 litigations involving mitral valve replacement were included in this analysis. The mean age of patients was 55.2 years and proportion of female patients was 32.7% in aortic valve replacements litigations, compared to a mean age of 54.1 years and female patients in 61.8% of mitral valve replacements litigations. Significant relationships exist between an alleged failure to monitor the patient and defendant verdicts (p=0.01), delayed treatment and defendant verdicts (p=0.04), and incidence of infective endocarditis and plaintiff verdicts (p=0.04) in aortic valve replacement litigations. Similarly, significant relationships exist between an alleged failure to diagnose and settlement verdicts (p=0.047), and stroke incidence and defendant verdicts (p=0.03) in mitral valve replacement litigations. CONCLUSIONS In addition to excellent surgeon patient/family communication, administering surgical treatment in a timely manner, diagnosing and acting on concomitant medical conditions, and close patient monitoring may diminish medical malpractice litigation involving aortic and mitral valve replacement operations.
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Affiliation(s)
| | - Frank W Sellke
- Warren Alpert Medical School, Brown University, Providence, RI, USA.,Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI, USA
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Mitchell RS. Commentary: Malpractice litigation and acute aortic dissection: What are the odds? J Thorac Cardiovasc Surg 2021; 164:611-612. [PMID: 34417048 DOI: 10.1016/j.jtcvs.2021.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Affiliation(s)
- R Scott Mitchell
- Stanford University School of Medicine, Stanford, Calif; VA Hospital, Palo Alto, Calif.
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Luc JGY, Lee R. Malpractice litigation: The unmeasured complication. J Thorac Cardiovasc Surg 2021; 164:e95. [PMID: 33640123 DOI: 10.1016/j.jtcvs.2020.12.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Jessica G Y Luc
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, Ga
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Palaniappan A, Sellke FW. Reply: Medicolegal research: A key to the locked door of patient expectations. J Thorac Cardiovasc Surg 2021; 164:e96-e97. [PMID: 33516460 DOI: 10.1016/j.jtcvs.2020.12.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Ashwin Palaniappan
- Alpert Medical School, Brown University, Providence, RI; Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI
| | - Frank W Sellke
- Alpert Medical School, Brown University, Providence, RI; Division of Cardiothoracic Surgery, Rhode Island Hospital, Providence, RI
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Mick SL, Girardi LN. Commentary: Ambushed by a snow leopard: Malpractice litigations involving aortic dissection. J Thorac Cardiovasc Surg 2020; 164:610-611. [PMID: 33277028 DOI: 10.1016/j.jtcvs.2020.10.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Stephanie L Mick
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
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Ikonomidis KR, Ikonomidis JS. Commentary: Medical malpractice litigation for aortic dissection: Heads they win; tails we lose. J Thorac Cardiovasc Surg 2020; 164:609-610. [PMID: 33277022 DOI: 10.1016/j.jtcvs.2020.10.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Krystal R Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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