The Annals of thoracic surgery
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Comparative Study
Long-term survival after lobectomy for non-small cell lung cancer by video-assisted thoracic surgery versus thoracotomy.
Video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) is increasingly popular. However, the oncologic soundness of VATS for patients with NSCLC as measured by long-term survival has not been proven. The objective here is to determine the overall survival (OS) and disease-free survival (DFS) in two well-matched groups of patients with NSCLC resected by VATS or thoracotomy. ⋯ For patients with clinical stage I NSCLC, VATS lobectomy offered similar OS and DFS compared with thoracotomy. Thoracotomy offers a more thorough lymph node evaluation, and may be appropriate for patients with more advanced clinical disease.
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Blood product transfusion during cardiopulmonary bypass has been demonstrated to be associated with increased morbidity and mortality in adult cardiac surgery populations. The aim of this study was to characterize the risk-adjusted occurrence of postoperative complications and mortality in relation to intraoperative blood product transfusion in our pediatric cardiac surgery population. ⋯ Blood product transfusion was associated with an increased incidence of postoperative pulmonary complications and prolonged hospital length of stay, but not overall mortality. These findings suggest that minimizing blood product transfusion would be beneficial in the pediatric cardiopulmonary bypass surgery patient population.
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Review Case Reports
Severe allergic dermatitis after closure of foramen ovale with Amplatzer occluder.
Allergic reaction to nitinol is rarely reported, and its incidence, symptoms, and course have not been clearly defined. We report an occurrence of severe progressive generalized exanthema 3 days after the implantation of an Amplatzer occluder for a patent foramen ovale, with symptoms disappearing immediately after surgical removal of the device 3 months later. The risks and possible prevention of allergic reaction to nickel and especially to titanium are discussed.
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Comparative Study
The impact of previous catheter-based ablation on the efficacy of the Cox-maze IV procedure.
Failed catheter-based ablation for the treatment of atrial fibrillation is an indication for the Cox-maze procedure. Many patients are referred for the Cox-maze IV procedure with recurrent atrial fibrillation after a previous catheter-based ablation, but the efficacy and safety of surgical management in these patients remains unclear. ⋯ The Cox-maze IV procedure is safe and effective in treating recurrent atrial fibrillation regardless of previous catheter ablation history. Surgical management should be considered in patients who have failed catheter ablation for the treatment of their atrial fibrillation.
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Comparative Study
A national study of nodal upstaging after thoracoscopic versus open lobectomy for clinical stage I lung cancer.
Nodal upstaging after surgical intervention for non-small cell lung cancer (NSCLC) occurs when unsuspected lymph node metastases are found during the final evaluation of surgical specimens. Recent data from The Society of Thoracic Surgery (STS) database demonstrated significantly lower nodal upstaging after thoracoscopic (VATS) lobectomy than after thoracotomy. STS data, however, may be biased from voluntary reporting, and survival was not investigated. We used a complete national registry to compare nodal upstaging and survival after lobectomy by VATS or thoracotomy. ⋯ National data confirm that nodal upstaging was lower after VATS than after open lobectomy for clinical stage I NSCLC. Multivariate survival analysis, however, showed no difference in survival, indicating that differences in nodal upstaging result from patient selection for reasons not captured in our registry.