The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Gene expression profiles in esophageal adenocarcinoma predict survival after resection.
The incidence of esophageal adenocarcinoma is rapidly increasing in the western population. Despite aggressive treatment, survival after esophagectomy is suboptimal. The main objective of the present study was to evaluate the gene expression profiles in esophageal adenocarcinoma and determine their association with survival after resection. ⋯ Global gene expression levels were significantly associated with overall survival after esophagectomy. Furthermore, individual genes could be successfully combined into a strongly predictive, internally cross-validated gene signature. If validated further, these results could help direct additional clinical trials of neoadjuvant and adjuvant therapies for esophageal adenocarcinoma.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Computational fluid dynamic simulations for determination of ventricular workload in aortic arch obstructions.
The cardiac workload associated with various types of aortic obstruction was determined using computational fluid dynamic simulations. ⋯ The present study has determined the hemodynamic significance of aortic arch obstruction using computational simulations to calculate the cardiac workload. These results suggest that all types of hypoplasia pose more of a workload challenge than coarctation with an equivalent degree of narrowing.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyExcellent short- and long-term outcomes after concomitant aortic valve replacement and coronary artery bypass grafting performed by surgeons in training.
No previous studies have specifically addressed the effect of training on outcomes after concomitant aortic valve replacement and coronary artery bypass grafting. This study evaluated the early and late outcomes after concomitant aortic valve replacement and coronary artery bypass grafting performed by surgeons in training. ⋯ Concomitant aortic valve replacement and coronary artery bypass grafting can be safely and effectively performed by properly supervised trainees in the contemporary era. It is imperative to offer training opportunities to junior surgeons in this complex procedure to ensure quality patient outcomes in the future.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Nationwide outcomes of surgical embolectomy for acute pulmonary embolism.
The aim of the present study was to review nationwide outcomes of surgical embolectomy for acute pulmonary embolism. ⋯ This large-cohort analysis of more than 2700 patients demonstrates a nationwide inpatient mortality rate of 27.2% after pulmonary embolectomy. Although patient factors affect mortality, the arena of care appears to have no significant effect on operative outcomes. This suggests that it might be more prudent for centers with qualified surgeons to avoid delays in treatment, rather than transfer care because of a perception of improved outcomes.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Heart transplant graft survival is improved after a reduction in panel reactive antibody activity.
Allosensitization in potential orthotopic heart transplant recipients is evaluated with the panel reactive antibody assay. Sensitized patients have prolonged wait times and increased waitlist and post-transplant mortality. Although low panel reactive antibody activity at the time of orthotopic heart transplantation is associated with improved outcomes, literature regarding the survival benefit of a panel reactive antibody reduction in the sensitized orthotopic heart transplant recipient remains limited. ⋯ Sensitized patients who had a substantial reduction in panel reactive antibody activity had an associated decline in the incidence of graft failure compared with those without a panel reactive antibody activity reduction. These results support efforts to reduce panel reactive antibody activity before orthotopic heart transplantation in patients with high panel reactive antibody activity.