The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Sep 2018
Comparative StudyCurrent Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study.
Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. ⋯ In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.
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Thorac Cardiovasc Surg · Aug 2018
Two-Stage Indicators to Assess Learning Curves for Minimally Invasive Ivor Lewis Esophagectomy.
Minimally invasive esophagectomy (MIE) Ivor Lewis has been increasingly performed over the last two decades. To guide the implementation of this technically demanding procedure, a comprehensive assessment of MIE-Ivor Lewis learning curves should include both the general competence to accomplish the procedure and the ability to generate oncological benefits. These objectives are believed to be associated with different phases of the learning curve. ⋯ An MIE-Ivor Lewis learning curve should include three discrete phases that indicate, successively, unskilled operation (general competence to accomplish, less proficiency), surgical proficiency, and oncological efficacy. Intrathoracic anastomosis time and bilateral RLN lymphadenectomy were identified as suitable indicators delineate the different stages of an MIE-Ivor Lewis learning curve.
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Thorac Cardiovasc Surg · Jun 2018
ReviewThe Value of Circulating Biomarkers in Bicuspid Aortic Valve-Associated Aortopathy.
Traditional risk stratification model of bicuspid aortic valve (BAV) aortopathy is based on measurement of maximal cross-sectional aortic diameter, definition of proximal aortic shape, and aortic stiffness/elasticity parameters. However, conventional imaging-based criteria are unable to provide reliable information regarding the risk stratification in BAV aortopathy, especially considering the heterogeneous nature of BAV disease. Given those limitations of conventional imaging, there is a growing clinical interest to use circulating biomarkers in the screening process for thoracic aortic aneurysms as well as in the risk-assessment algorithms. We aimed to systematically review currently available biomarkers, which may be of value to predict the natural evolution of aortopathy in individuals with BAV.
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Thorac Cardiovasc Surg · Jun 2018
Comparative StudyPropensity Score Adjusted Comparison of Minimally Invasive versus Open Thymectomy in the Management of Early Stage Thymoma.
The benefits of minimally invasive versus open thymectomy for the management of thymoma are debatable. Further, patient factors contributing to the selection of operative technique are not well elucidated. We aim to identify the association between baseline patient characteristics with choice of surgical approach. ⋯ Baseline patient characteristics were not associated with surgical approach selected for thymectomy. Minimally invasive thymectomy patients had shorter LOS but no significant differences in 90-day composite morbidity and recurrence or mortality. Larger multicenter studies are needed to evaluate factors contributing to patient selection for each approach, which may include surgeon preference.
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Thorac Cardiovasc Surg · Jun 2018
Comparative StudySurvival and Long-Term Outcomes of Aortic Valve Replacement in Patients Aged 55 to 65 Years.
This study aims to compare the outcomes after aortic valve replacement (AVR) with mechanical and biological valves in middle-aged patients (55-65 years) to determine the impact on long-term mortality and morbidity. ⋯ There is no difference in survival and MAPE at 15 years between biological and mechanical valves. The risk of reoperation was significantly higher in the biological valve group and may affect valve choice in middle-aged patients.