The Annals of thoracic surgery
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Appropriate choice of Fontan pathway requires keen preoperative examination of angiographic anatomy. We hypothesize that surgical choices may be better informed by lessons learned from postoperative hemodynamic evaluation in different Fontan connection strategies. ⋯ Considering cycle-averaged Eloss, HFD, and peak inferior vena cava flow Eloss, DCPC had the best hemodynamic performance. Intraatrial conduit Fontan is an efficient modification of lateral tunnel Fontan that offers possibility for excellent streamlining of inferior vena cava and superior vena cava with the pulmonary arteries.
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Recent studies have shown that bilateral pulmonary artery banding (bil-PAB) for hypoplastic left heart syndrome (HLHS) is not superior to the neonatal Norwood procedure in terms of overall mortality and neurodevelopmental outcome. We tested our hypothesis that bil-PAB is associated with negative hemodynamic effects on cerebral circulation. ⋯ A hybrid approach followed by comprehensive stage II palliation may not be an optimal strategy for HLHS and should be evaluated further.
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Tricuspid valve (TV) infective endocarditis (IE) accounts for 15% of IE cases and usually is treated medically. Surgical intervention is rare, and understanding of treatment options is based on small series of patients. The purpose of this study was to describe the population and outcomes for isolated TV IE using The Society of Thoracic Surgeons Adult Cardiac Database. ⋯ Isolated TV operation for IE is a rare clinical entity with a similar operative mortality to left-sided IE operations. Repair and replacement of the TV had similar perioperative mortality. Patients in the healed TV IE group demonstrated lower complication rates, length of stay, and a trend toward decreased mortality.
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Nonexamination of lymph nodes is an extreme example of the variability of pathologic nodal staging of non-small cell lung cancer. We compared the prevalence, characteristics, and survival of patients without lymph nodes (pNX) to patients with documented pathologic N0 and pathologic N1 non-small cell lung cancer. ⋯ Patients with pNX resections are a high-risk subset, with survival approximating pathologic N1, not N0. They should have further attempts at retrieving lymph nodes for examination or be offered postoperative adjuvant chemotherapy. We predict that treatment modalities that fail to address lymph nodes are likely to yield inferior survival in comparison to surgery with proper lymph node examination. The proportion of pNX lung resections may be a sentinel quality indicator for lung cancer programs.