The Annals of thoracic surgery
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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.
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Comparative Study
Sublobar resection versus definitive radiation in patients with stage IA non-small cell lung cancer.
Many patients with resectable non-small cell lung cancer (NSCLC) are unfit for lobectomy owing to comorbidity. Surgical outcomes are biased by preoperative selection factors and upstaging that occurs during surgery. This study compares outcomes between sublobar pulmonary resection and traditional external beam radiation therapy. ⋯ Sublobar resection without lymph node sampling appears to be superior to radiotherapy for clinical stage IA NSCLC. For patients with prohibitive risk for lobectomy, sublobar resection may be preferable to radiotherapy. Radiotherapy results in current and future patients are likely to be better.
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Penetrating aortic ulcers (PAU) often occur in a debilitated elderly population. Although early results of repair for PAU are well described, late outcomes remain poorly characterized and are the focus in this report. ⋯ Despite the presence of an older, more complex TEVAR group, late outcomes after repair for PAU were affected more by age and type of presentation than by treatment strategy. Recognizing the perils of intervention in this high-risk population, TEVAR emerges as the therapy of choice to reduce early morbidity and provide similar late survival.
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Despite the proven benefits in hemorrhagic shock, blood transfusions have been linked to increased morbidity and mortality. The short-term adverse effects of blood transfusion in cardiac surgical patients are well documented but there are very few studies that adequately assess the long-term survival. This study was undertaken to evaluate the effects of transfusion on both short-term and long-term survival after cardiac surgery. ⋯ This study suggests that blood or blood product transfusion during or after cardiac surgery is associated with increased short-term and long-term mortality. It reinforces the need for prospective randomized controlled studies for evaluation of restrictive transfusion triggers and objective clinical indicators for transfusion in the cardiac surgical patient population.
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Even if the thoracic endovascular aortic repair or open stent grafting technique becomes popular, surgical total arch replacement is still important and will continue to be necessary. Distal anastomosis of total arch replacement is critical in this procedure. This article describes an easy and useful method for using a malleable retractor ring in the distal anastomosis of the total arch replacement.