The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyMechanical versus bioprosthetic mitral valve replacement in patients <65 years old.
Because of its durability, the mechanical valve is typically chosen for young patients undergoing mitral valve replacement (MVR). However, a bioprosthetic valve might have the benefit of valve-in-valve transcatheter valve replacement when valve failure occurs. We examined the outcomes in patients who had undergone mechanical valve MVR (MVRm) versus bioprosthetic valve MVR (MVRb) in patients aged <65 years. ⋯ In the present report, MVRb for patients <65 years old was associated with a high reoperation rate and decreased survival. Although a future transcatheter valve-in-valve technique for a failed bioprosthetic valve might reduce the risk of reoperation, this finding confirms the safety of mechanical valves in this group.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyMinimal-dose computed tomography is superior to chest x-ray for the follow-up and treatment of patients with resected lung cancer.
A minimal-dose computed tomography scan of the thorax (MnDCT) delivers a radiation dose comparable with a chest x-ray (CXR). We hypothesized that in patients with completely resected lung cancer, surveillance with MnDCT, when compared with CXR, leads to earlier detection and a higher rate of treatment of new or recurrent lung cancer. ⋯ After curative resection of lung cancer, MnDCT is superior to CXR for the detection of new or recurrent lung cancer. The majority of new or recurrent cancer was detected by MnDCT at an asymptomatic phase, allowing for curative treatment, leading to a long survival.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyManagement of tricuspid regurgitation in congenital heart disease: is survival better with valve repair?
Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes. ⋯ Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Parameters for successful nonoperative management of traumatic aortic injury.
Blunt traumatic aortic injury is associated with significant mortality, and increased computed tomography use identifies injuries not previously detected. This study sought to define parameters identifying patients who can benefit from medical management. ⋯ All blunt traumatic aortic injury does not necessitate repair. Stratification by injury grade and secondary signs of injury identifies patients appropriate for medical management. Grade IV injury necessitates emergency procedures and carries high mortality. Grade III injury with secondary signs of injury should be urgently repaired; patients without secondary signs of injury may undergo delayed repair. Grade I and II injuries are amenable to medical management.
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J. Thorac. Cardiovasc. Surg. · Jan 2014
Comparative StudyCombined heart-kidney transplant improves post-transplant survival compared with isolated heart transplant in recipients with reduced glomerular filtration rate: Analysis of 593 combined heart-kidney transplants from the United Network Organ Sharing Database.
Criteria for simultaneous heart-kidney transplant (HKTx) recipients are unclear. We characterized the evolution of combined HKTx in the United States over time compared with isolated heart transplantation (HTx) and determined factors maximizing post-transplant survival. We focused on whether a threshold estimated glomerular filtration rate (eGFR) could be identified that justified combined transplantation. ⋯ Performance of combined HKTx is increasing out of proportion to isolated HTx. eGFR is an important determinant of improved HTx survival. Combined HKTx recovers post-transplant survival in patients with eGFR <37 mL/minute and can be recommended in this subgroup.