The Annals of thoracic surgery
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Comparative Study
Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era.
In the era of destination continuous flow left ventricular assist devices (LVAD), the decision of whether a patient will tolerate isolated LVAD support or will need biventricular support (BIVAD) can be challenging. Incorrect decision making with delayed right ventricular (RV) assist device implantation results in increased morbidity and mortality. Continuous flow LVADs have been shown to decrease pulmonary hypertension and improve RV function. We undertook this study to determine predictors in the continuous flow LVAD era that identify patients who are candidates for isolated LVAD therapy as opposed to biventricular support. ⋯ We present a preoperative risk calculator to determine suitability of a patient for isolated LVAD support in the current continuous flow ventricular assist device era.
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Comparative Study
The role of cardiac resynchronization therapy for arterial switch operations complicated by complete heart block.
As mortality in patients with D-loop transposition of the great arteries (D-TGA) has decreased after the arterial switch operation (ASO), the focus has shifted to higher risk groups and outcomes that impact long-term morbidity and mortality, such as left ventricular (LV) dysfunction. We sought to examine the perioperative factors associated with LV dysfunction in patients with D-TGA and ventricular septal defects (VSD) after ASO. ⋯ Left ventricular dysfunction after surgical repair for D-TGA/VSD is low, with heart block and pacemaker insertion playing a significant role. The LV function improved after patients were upgraded to a CRT device.
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Comparative Study
Single-incision thoracoscopic lobectomy and segmentectomy with radical lymph node dissection.
Reports of single-incision thoracoscopic lobectomy and segmentectomy are rare. In this article, we present our experience with single-incision thoracoscopic lobectomy and segmentectomy and radical mediastinal lymph node dissection. ⋯ Single-port VATS lobectomy and segmentectomy is safe and feasible for selected patients.
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Comparative Study
Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction.
Chest wall remodeling by substernal placement of a Nuss bar is the treatment of choice for children with pectus excavatum; however, it has not yet gained widespread acceptance in adults. We demonstrate that thoracoscopic Nuss bar insertion in young adults is safe and leads to excellent results. ⋯ For young adults who wish to correct their pectus deformity, a thoracoscopic Nuss procedure is safe and results in a high rate of patient satisfaction, significant improvement in self-image, and excellent midterm cosmetic results.
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We present a case of an abnormal origin of right subclavian artery and right vertebral artery distal to the origin of left subclavian artery in a 2-year-old patient who presented with cyanotic congenital heart disease with single ventricle physiology. The anomalous origin of a right vertebral artery from the proximal descending thoracic aorta is very rare. We have described the cine-angiographic identification of its origin and course, its embryologic development, and its clinical relevance.