General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Jan 2019
ReviewReflection of pioneers: redo thoracoabdominal aortic aneurysm repair controversies in thoracic aortic aneurysm surgery.
Reoperative thoracoabdominal aortic aneurysm repair is frequently necessary and brings with it a unique set of challenges. Typically, most reoperative repairs are necessitated by aortic disease progressing into previously healthy aortic tissue from a replaced section of the aorta (an extension of the previous repair) or, to a lesser degree, because of a late complication of prior distal aortic repair (an open or endovascular repair failure). ⋯ Since the introduction of endovascular repair for aortic aneurysms, indications for open repair have become more specific and limited; many centers have justified using endovascular approaches in patients with prior open aortic repair by deeming these patients "high risk" because of their previous incision. Our analysis found that reoperative repairs were not typically subject to worse early outcomes than patients without prior distal aortic repair, except for the more complicated types of reoperation, which involve infection.
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Gen Thorac Cardiovasc Surg · Jan 2019
PRO-CON debate: valve sparing aortic root surgery. PRO: reimplantation.
The remodeling and the reimplantation procedures were described more than 25 years ago with the aim of sparing, otherwise normal aortic valve in the presence of a root aneurysm. Because of its ability to reconstruct the sinuses of Valsalva, the remodeling procedure was considered to be more physiological than the reimplantation. ⋯ In this way, both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. Today preference for a reimplantation procedure is based on the perception of a better reproducibility of the surgical procedure, an increased procedural safety due to the characteristic hemostatic feature of this surgical approach, and to a much larger amount of data present in the literature on long-term results.
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Gen Thorac Cardiovasc Surg · Dec 2018
Analysis of surgical treatment of Masaoka stage III-IV thymic epithelial tumors.
The purpose of this study is to elucidate the outcomes after surgical resection of Masaoka stage III-IV thymic epithelial tumors. ⋯ Patients with Masaoka stage III-IV thymic epithelial tumor showed relatively favorable long-term survival after surgical treatment. Therefore, aggressive surgical resection for complete resection may be a treatment option for these conditions.
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Gen Thorac Cardiovasc Surg · Nov 2018
Preoperative nutritional status is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery.
Progression of cardiac rehabilitation after cardiovascular surgery can be affected by frailty. The nutritional status of the patient has been proposed as an indicator of frailty. In this study, we aimed to evaluate the influence of preoperative nutritional status on the progress of postoperative cardiac rehabilitation. ⋯ Preoperative nutritional status was associated with progression of postoperative cardiac rehabilitation.
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Gen Thorac Cardiovasc Surg · Sep 2018
ReviewEditorial comment regarding "Total aortic arch replacement using the frozen elephant trunk technique with J Graft Open Stent Graft for distal aortic arch aneurysm".
Total aortic arch replacement using the frozen elephant trunk (FET) technique has gained worldwide popularity, because it has simplified the treatment of complicated thoracic aortic lesions. The most effective use of FET has been total arch repair for acute-type A aortic dissection because of its particularly favorable prognosis. ⋯ The incidence of FET-related paraplegia has decreased with the use of total aortic arch replacement but is still higher than in classic total arch replacement with distal arch anastomosis. A prospective multicenter study for FET is necessary.