The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Omental reinforcement of the thoracic esophagogastric anastomosis: an analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy.
An uncontained thoracic anastomotic leak may cause severe morbidity or mortality. Thoracic transposition of an omental flap along with the gastric conduit may decrease leak incidence, severity, or need for reoperations after esophagectomy. ⋯ Omental reinforcement of thoracic esophagogastric anastomoses decreases overall leak rate and need for reoperation. We recommend pedicled omental transposition to reinforce all thoracic anastomoses. Endoscopic evaluation of significant anastomotic leaks is still warranted.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Comparative StudyDifferences in reported esophageal cancer resection outcomes between national clinical and administrative databases.
The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) is the largest clinical thoracic surgical database in the United States. The purpose of the present study was to determine whether the GTSD esophagectomy outcomes are representative of nationwide outcomes by comparing them with other national clinical and administrative databases. ⋯ The STS GTSD reports outstanding mortality results and hospital length of stay for esophageal cancer resection. However, the surgical outcomes from the STS GTSD are not representative of the national results from programs not participating in the database. These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and use of the STS GTSD.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Transplantation of initially rejected donor lungs after ex vivo lung perfusion.
Ex vivo lung perfusion has the potential to increase the number of patients treated with lung transplantation. Our initial clinical experience with ex vivo lung perfusion is reviewed as well as early clinical outcome in patients transplanted with reconditioned lungs. ⋯ The use of ex vivo lung perfusion seems safe and indicates that some lungs otherwise refused for lung transplantation can be recovered and transplanted with acceptable short-term results.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Pulmonary hypertension is associated with worse early and late outcomes after aortic valve replacement: implications for transcatheter aortic valve replacement.
Our objectives were to determine the prevalence of pulmonary hypertension (PHT) in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis (AS), characterize risk for PHT, assess changes in PHT, and analyze its effect on outcomes. ⋯ Most patients undergoing primary AVR have at least moderate PHT that is not relieved by AVR; its severity is associated with mortality, serious complications, and worse late survival. PHT severity should be included in risk assessment before aortic valve intervention. These outcomes suggest that earlier intervention for AS warrants further study.
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J. Thorac. Cardiovasc. Surg. · Nov 2012
Surgical ablation of atrial fibrillation trends and outcomes in North America.
Despite growing awareness of the clinical significance of atrial fibrillation (AF) and observational data demonstrating the safety and efficacy of surgical therapy, AF ablation is variably performed among patients with AF undergoing cardiac surgery. We examined the national trends of surgical ablation and perioperative outcomes for stand-alone surgical ablation of AF. ⋯ The prevalence of AF in patients undergoing cardiac surgery has increased, as has the number of stand-alone surgical ablations. The treatment of concomitant disease declined slightly. Isolated surgical ablation is safe, performed "on" or "off" cardiopulmonary bypass. These results support consideration of surgical AF ablation as an alternative to percutaneous ablation for patients with lone AF.