The Annals of thoracic surgery
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Comparative Study
Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients.
An open thymectomy is a morbid procedure. If a minimally invasive thymectomy is performed without compromising the tenets of thymic surgery, it has the potential for decreasing morbidity and may offer similar clinical and oncologic results. ⋯ Minimally invasive thymectomy is safe and achieves a comparable resection and postoperative complication profile when used selectively for all indications, including myasthenia gravis and small thymomas without vascular invasion.
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Valve surgery is performed routinely in octogenarians. This study explored variables affecting patient discharge disposition (home versus other facility) and whether patient disposition was related to long-term survival. ⋯ Octogenarians can expect excellent survival after valve surgery. Those not discharged home had poorer long-term survival. Therefore, adequate resources should be secured so sicker patients receive the appropriate level of care.
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Comparative Study
Should orthotopic heart transplantation using marginal donors be limited to higher volume centers?
This study examined whether institutional volume impacts outcomes after orthotopic heart transplantation (OHT) utilizing marginal donors. ⋯ Consolidating the use of marginal donors to higher volume centers may be prudent in improving post-OHT outcomes in this higher risk patient subset.
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Complications may arise from the residual dissected arch and descending thoracic aorta after conventional ascending and hemiarch repair of acute DeBakey type I aortic dissection. To mitigate these complications, a total arch and elephant trunk procedure has been advocated. This case demonstrates a less invasive hybrid technique, performed in a single-stage fashion through a sternotomy without circulatory arrest or deep hypothermia, to achieve the benefits of the total arch and elephant trunk operation.
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Metastatic pulmonary angiosarcomas frequently present with pneumothorax, especially those arising from the scalp. The metastases on chest radiographs are initially subtle and easily missed. ⋯ We report a patient who presented with pneumothorax and lung cysts before his primary scalp angiosarcoma was diagnosed. This case highlights the sometimes ominous nature of innocuous-looking, thin-walled cystic pulmonary lesions.