The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyOrthotopic heart transplant versus left ventricular assist device: a national comparison of cost and survival.
Orthotopic heart transplantation is the standard of care for end-stage heart disease. Left ventricular assist device implantation offers an alternative treatment approach. Left ventricular assist device practice has changed dramatically since the 2008 Food and Drug Administration approval of the HeartMate II (Thoratec, Pleasanton, Calif), but at what societal cost? The present study examined the cost and efficacy of both treatments over time. ⋯ Since Food and Drug Administration approval of the HeartMate II, mortality after left ventricular assist device implantation has decreased rapidly, yet has remained greater than that after orthotopic heart transplantation. The left ventricular assist device costs have continued to increase and have been significantly greater than those for orthotopic heart transplantation. Because of the evolving healthcare economics climate, with increasing emphasis on the costs and comparative effectiveness, a concerted effort at LVAD cost containment and judicious usage is essential to preserve the viability of this invaluable treatment.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Quality of life and survival of septuagenarians and octogenarians after repair of descending and thoracoabdominal aortic aneurysms.
We assessed quality of life and survival in elderly patients after complex aortic operations to aid in surgical decision making. ⋯ TAAA repair in this selected older surgical population yields acceptable survival beyond the first year. Among 1-year survivors, quality of life is similar to that of an age- and gender-matched population.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Comparative StudyIntraoperative hyperthermic chemotherapy perfusion for malignant pleural mesothelioma: an in vitro evaluation.
Hyperthermic chemotherapy perfusion has been used in the treatment of both pleural and peritoneal mesothelioma without an extensive basic science foundation. Clinical data are limited with no prospective randomized trials to support the use of this potentially toxic therapy. We sought to generate basic scientific support for this clinical practice and to define the optimal conditions for use in future clinical trials. ⋯ Intrapleural chemotherapy seems to be most effective when using 2 drug combinations. All mesothelioma cell lines showed no particular sensitivity to heat. The use of hyperthermia alone or with chemotherapy produces at best only a modest effect and does not necessarily support its current clinical use.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Late outcome of repair of congenital coronary artery fistulas--a word of caution.
We reviewed our experience with repair of congenital coronary artery fistulas. ⋯ Perioperative myocardial infarction is an important complication of ligation of coronary artery fistulas and can contribute to reduced late survival. The tricuspid valve should be evaluated carefully at repair because of the relatively high rate of residual regurgitation in survivors.
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J. Thorac. Cardiovasc. Surg. · Feb 2013
Patient-prosthesis mismatch after transapical aortic valve implantation: incidence and impact on survival.
Transcatheter aortic valve implantation (TAVI) has become an important therapeutic option for high-risk patients with severe aortic valve stenosis. Patient-prosthesis mismatch (P-PM) is an important determinant of morbidity and mortality after open aortic valve replacement. The objective of our study was to evaluate P-PM incidence and its impact on survival in a large cohort of patients treated with TAVI. ⋯ P-PM is found in patients undergoing transapical TAVI. Severe mismatch is accompanied by high early mortality, especially when combined with increased pressure gradients.