The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Expanding relevance of aortic valve repair-is earlier operation indicated?
To define the durability of aortic valve repair (AVRep) and the effect of surgical timing on late survival. ⋯ AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable anatomy.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyPreoperative percutaneous coronary intervention in patients undergoing open thoracoabdominal and descending thoracic aneurysm repair.
Current guidelines have recommended against coronary revascularization before noncardiac surgery in patients with asymptomatic coronary artery disease. However, myocardial infarction after thoracic aneurysm (TA) repair dramatically increases the morbidity and mortality. Revascularization with coronary artery bypass grafting before TA repair minimizes the incidence of perioperative ischemia. However, the recovery can be prolonged, and a percentage of patients will either never return for aneurysm repair or will develop a rupture during convalescence. Percutaneous coronary intervention (PCI) before TA repair might be preferable. Previous studies examining PCI before major vascular surgery included few patients with TAs. We examined the outcomes of patients undergoing PCI before TA repair. ⋯ PCI is safe and efficacious in patients undergoing TA repair. Aneurysm rupture did not occur in the interval before surgery. Antiplatelet therapy did not increase the risk of bleeding complications. Stent thrombosis was not seen. We recommend PCI those with significant single- or double-vessel coronary artery disease before elective TA repair.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Assessment of functional tricuspid regurgitation using 320-detector-row multislice computed tomography: risk factor analysis for recurrent regurgitation after tricuspid annuloplasty.
Functional tricuspid regurgitation (TR) often develops secondary to left heart disease. Tricuspid annuloplasty (TAP) is usually the treatment of choice for significant TRs, but recurrence of TR after surgery can occur. Previous studies have not clearly demonstrated the cause of the recurrent TR after TAP. By using an electrocardiogram-gated 320-detector-row multislice computed tomography (CT), we sought to delineate the morphologic cause of the incompetent tricuspid valve and identify the risk factors for recurrent TR. ⋯ TVAD, tethering angles, and tethering height correlated significantly with preoperative TR severity. The tethering height of the tricuspid valve showed significant correlation with recurrent TR.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Observational StudyClinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting.
Intracoronary shunts have been developed for a bloodless field and preserved forward flow preventing ischemia during off-pump coronary artery bypass (OPCAB) surgery. However, reports directly measuring the forward flow through the shunt in clinical settings are lacking. ⋯ The LAD flow is preserved at least 50% through a 1.5-mm intracoronary shunt, although the flow pattern was attenuated, during OPCAB anastomosis. The Doppler evaluation of the coronary artery flow before and after shunting is useful to justify the protective use of the shunt on myocardial perfusion during OPCAB.
-
J. Thorac. Cardiovasc. Surg. · Jan 2014
Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters.
The International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) have collaborated to propose a new pathologic classification of lung adenocarcinoma. In this classification, noninvasiveness and invasiveness have been newly defined for lung adenocarcinoma. The aims of this study were to validate the prognostic significance of tumor invasiveness as defined by the new IASLC/ATS/ERS classification and to assess the relationship between pathologic invasiveness and radiologic findings in pathologic stage IA lung adenocarcinoma. ⋯ We found that by using the new IASLC/ATS/ERS classification, histologic subtypes of pathologic stage IA lung adenocarcinoma with prognostic value could be identified. Tumor invasiveness of lung adenocarcinoma as defined by this classification can be predicted by evaluating the ground-glass opacity ratio, tumor disappearance rate, and consolidation diameter on thin-section computed tomography.