The Annals of thoracic surgery
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Comparative Study
Long-Term Impact of Cytomegalovirus Serologic Status on Lung Transplantation in the United States.
Cytomegalovirus (CMV) infection has been associated with poor outcomes after solid organ transplantation. The long-term impact of donor and recipient CMV serological status on lung transplant outcomes remains unclear. Accordingly, we evaluated the impact of donor and recipient CMV status on long-term patients as well as allograft survival after single (SLT) and double lung transplantation (BLT). ⋯ CMV seronegative recipients undergoing either BLT or SLT from CMV seropositive donors have the highest risk of long-term mortality that extends beyond the first year. Further studies are needed to determine the causes of higher mortality observed in the CMV seronegative recipients and risks and benefits of extension of CMV prophylaxis, particularly in the high-risk group.
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Comparative Study
Comparison Between Esophagectomy and Definitive Chemoradiotherapy in Patients With Esophageal Cancer.
This study compared survival between definitive chemoradiotherapy (CRT) and esophagectomy alone among patients with locoregional esophageal squamous cell carcinoma (SCC). ⋯ Esophagectomy alone could provide better survival than definitive CRT for patients with clinical stage I/II esophageal SCC. However, definitive CRT and esophagectomy yield similar overall survival rates in clinical stage III patients.
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Over the last decade, aortic valve replacement with rapid-deployment biologic bioprostheses has become a common alternative to the use of mechanical or biologic stented valves for high-risk patients. A 63-year-old patient underwent uncomplicated valve replacement with the Edwards Intuity valve (Edwards Lifesciences, Irvine, CA). ⋯ Both valves were replaced by a conventional stented bioprosthesis. This case report describes the first case of valve migration for the Edwards Intuity Elite rapid-deployment aortic valve and discusses possible explanations.
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Multicenter Study Observational Study
Exploring Shared Mental Models of Surgical Teams in Video-Assisted Thoracoscopic Surgery Lobectomy.
Nontechnical skills are important for safe and efficient surgery. Teams performing video-assisted thoracoscopic surgery (VATS) lobectomy express that it is of utmost importance to have a shared mental model (SMM) of the patient, current situation, and team resources. However, these SMMs have never been explored in a clinical setting. The aim of this observational study was to measure the similarity of SMMs within teams performing VATS lobectomy. ⋯ Significant variation exists in the SMMs among VATS team members, with poor agreement regarding the patient and current situation, but better agreement with respect to team resources. Focus on preoperative and perioperative team reflexivity, in addition to explicit communication within unfamiliar teams, may provide opportunities to enhance SMMs, with possible downstream effects on team performance.
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Multicenter Study
Cognition and Cerebral Infarction in Older Adults After Surgical Aortic Valve Replacement.
Aortic valve replacement (AVR) for calcific aortic stenosis is associated with high rates of perioperative stroke and silent cerebral infarcts on diffusion-weighted magnetic resonance imaging (MRI), but cognitive outcomes in elderly AVR patients compared with individuals with cardiac disease who do not undergo surgery are uncertain. ⋯ In high-risk, aged participants undergoing surgical AVR for aortic stenosis, postoperative cognitive dysfunction was surprisingly limited and was resolved by 1 year in most. Postoperative cognitive dysfunction at 4 to 6 weeks was associated with more and larger acute cerebral infarcts.