The Annals of thoracic surgery
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Randomized Controlled Trial
Amiodarone significantly decreases atrial fibrillation in patients undergoing surgery for lung cancer.
Postoperative atrial fibrillation occurs in 5% to 65% of patients undergoing thoracic surgery. Although postoperative atrial fibrillation often is regarded as a temporary, benign, operation-related problem, it is associated with a twofold to threefold increase in risk of adverse events, including transient or permanent stroke, acute myocardial infarction, and death. ⋯ Postoperative prophylaxis with a high dose of oral amiodarone after an intravenous bolus infusion is a safe, practical, feasible, and effective regimen for patients with lung cancer undergoing surgery. It significantly reduced the incidence of postoperative atrial fibrillation.
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Multicenter Study
Variation in outcomes for risk-stratified pediatric cardiac surgical operations: an analysis of the STS Congenital Heart Surgery Database.
We evaluated outcomes for groups of risk-stratified operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database to provide contemporary benchmarks and examine variation between centers. ⋯ This analysis documents contemporary benchmarks for risk-stratified pediatric cardiac surgical operations grouped by STAT Mortality Categories and the range of outcomes among centers. Variation was greatest for the more complex operations. These data may aid in the design and planning of quality assessment and quality improvement initiatives.
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Outcomes after atrioventricular (AV) valve operations in patients with functional single ventricles are unclear. ⋯ AV valve regurgitation is a considerable burden for the patient with a single ventricle, especially when appearing at a young age. A quarter of patients died within the first year after operation, and they had considerable morbidity in terms of reoperation, thromboembolic events, and pacemaker implantation. Their chances of reaching Fontan completion seemed decreased.
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Comparative Study
Comparison of thoracoscopic segmentectomy and thoracoscopic lobectomy for small-sized stage IA lung cancer.
Thoracoscopic lobectomy for lung cancer has been widely accepted, but thoracoscopic segmentectomy remains controversial because of the complexity of the procedure and of the fear of increased local recurrence. This study compared outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy in patients with small-sized (≤2 cm) stage IA non-small cell lung cancer. ⋯ Thoracoscopic segmentectomy is a safe option and provides comparable oncologic results to thoracoscopic lobectomy for small (≤2 cm) peripheral stage IA non-small cell lung cancer. Tumor size is an independent prognostic factor of disease-free survival for stage IA patients with small-sized lesions.
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Case Reports
Hybrid endovascular treatment of an anomalous right subclavian artery dissection in a patient with Marfan syndrome.
We report the case of a 26-year-old female patient with Marfan syndrome and an aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum. The patient presented with spontaneous acute dissection of the ARSA that showed fusiform dilation to 4 cm in diameter. Definitive treatment was performed using a two-stage hybrid endovascular technique, including extrathoracic bilateral upper extremity bypass and thoracic endovascular aortic repair with debranching of the right and left subclavian arteries. This was followed by coil and plug embolization to exclude the dissection and prevent subsequent endoleak.