The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2012
Comparative StudyCombined proximal stent grafting plus distal bare metal stenting for management of aortic dissection: Superior to standard endovascular repair?
The present study compared the outcomes between combined proximal descending aortic endografting plus distal bare metal stenting and conventional proximal descending aortic stent-graft repair in patients with type A and type B aortic dissection. ⋯ Combined proximal descending aortic endografting plus distal bare metal stenting for aortic dissection provides favorable short-term outcomes and decreases late distal aortic complications compared with conventional endovascular repair. These results support a more widespread application of this approach. A prospective, randomized trial is needed before definite conclusions can be made.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
Pattern of lymphatic spread in thoracic esophageal squamous cell carcinoma: A single-institution experience.
Lymph node metastasis is among the most important prognostic factors for patients with esophageal squamous cell carcinoma after curative esophagectomy; however, the extent of lymphadenectomy is still controversial. The objective of the present study was to determine the frequency of lymphatic metastases and to study the pattern of lymph node metastasis in a large study population. ⋯ Metastases were more frequent in the abdomen than in the neck. Total mediastinal and upper abdominal lymphadenectomy should be carefully conducted. Certain factors, such as tumor location, depth of tumor invasion, lymphovascular invasion, and paratracheal lymph node involvement, might be helpful in determining the need to perform cervical lymphadenectomy in individual patients.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
Prognostic value of myocardial fibrosis in patients with severe aortic valve stenosis.
To evaluate whether myocardial fibrosis influences left ventricular performance in severe aortic stenosis and to assess its effect on long-term survival after aortic valve replacement. ⋯ In patients with severe aortic valve stenosis, the amount of myocardial fibrosis appears to have significant effect on clinical status and long-term survival after aortic valve replacement. From these results, we believe that new strategies for the earlier detection of myocardial fibrosis are needed to achieve a better prognostic outcome.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
EditorialVentricular restraint therapy for heart failure: A review, summary of state of the art, and future directions.
Congestive heart failure is a leading cause of death in developed countries, and its incidence is expected to increase in parallel with the aging population. Most current therapies for congestive heart failure lead to modest symptom relief but are unable to significantly improve long-term survival outcomes. Indeed, there is no effective treatment except cardiac transplantation, which remains epidemiologically insignificant because of donor pool limitations. ⋯ In this review, the principles of cardiac restraint therapy will be discussed. An overview of 3 restraint devices, along with their specific advantages and disadvantages, will be presented. The existing peer-reviewed literature from both animal and human trials will be summarized with an emphasis on understanding the mechanism of restraint therapy and how this knowledge can be used to optimize and improve its efficacy.
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J. Thorac. Cardiovasc. Surg. · Oct 2012
Historical ArticleThe Thrombolysis in Myocardial Infarction (TIMI) Study Group experience.
The Thrombolysis in Myocardial Infarction (TIMI) study group, an academic research organization, was formed in 1984 with initial support from the National Heart, Lung, and Blood Institute. Its initial goal was to compare the effects of the then-new thrombolytic agent, recombinant tissue plasminogen activator, with streptokinase. The TIMI study group has remained active since then and has completed 50 multicenter clinical trials. ⋯ In addition to thrombolytic agents, TIMI has studied antithrombotic, antiplatelet, anti-ischemic, lipid lowering, and anti-inflammatory drugs. TIMI has also established robust biomarker and pharmacogenetics programs, and has devised a panel of risk assessment scores that are widely used. TIMI is currently conducting 7 large trials worldwide on novel agents designed to reduce the morbidity and mortality of a variety of cardiovascular disorders.