The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Endovascular repair of the ascending aorta in patients at high risk for open repair.
Although endovascular repair has been widely adopted for treatment of descending thoracic aortic pathologies, its role in ascending aortic pathologies remains undefined. We reviewed our experience with endovascular repair of ascending aortic pathologies in patients facing high or prohibitive risk with open surgical treatment. ⋯ Endovascular repair of ascending aortic pathology is feasible in patients facing high risk with open surgery, with promising early results. Technical challenges remain in adapting current endovascular technology to ascending aortic pathologies, particularly type A aortic dissection.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Indications and imaging for aortic surgery: size and other matters.
To review the current general concepts and understanding of the natural history of thoracic aortic aneurysm and their clinical implications. ⋯ Size continues to be a strong predictor of natural complications and a suitable parameter for intervention. As we enter the era of personalized aneurysm care, it is likely that specific genetic mutations will facilitate the determination of the appropriate size criterion for surgical intervention in individual cases.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Reprint of: Early and late outcomes of acute type A aortic dissection with intramural hematoma.
Controversy remains regarding management of acute type A dissection with intramural hematoma (IMH). Our purpose was to analyze our experience and report outcomes after repair of acute type A aortic dissection with IMH. ⋯ Repair of acute type A aortic dissection with IMH is associated with significant early morbidity and mortality, differing minimally from typical aortic dissection. Although expectant repair within 3 days may be applied, the purposeful delay imparted little advantage. Improved late outcomes may be seen with IMH, but continued long-term surveillance is required for verification.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Late clinical outcome of transient intraoperative systolic anterior motion post mitral valve repair.
Systolic anterior motion (SAM) after mitral valve repair with significant mitral regurgitation requires immediate reintervention. Transient SAM immediately after repair is usually managed by hemodynamic maneuvers. We investigated the late clinical and echocardiographic significance of postoperative transient SAM. ⋯ Late postoperative exercise stress echocardiogram revealed low incidence of SAM in patients with immediate postrepair transient SAM. All other late clinical outcomes were similar to those of non-SAM repair patients. Conservative management of intraoperative transient SAM is both successful and reliable.
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J. Thorac. Cardiovasc. Surg. · Feb 2015
Prognostic significance of a positive radial margin after esophageal cancer resection.
The prognostic significance of an incomplete esophageal cancer resection due to a positive microscopic radial margin remains unclear. The aim of this study is to examine the relationship between radial margin status and oncologic outcomes. ⋯ An isolated, positive microscopic radial margin was associated with a greater risk for distant recurrence. There was no impact on locoregional disease control. The role of adjuvant, systemic therapy in patients with an isolated, microscopically RM+ merits further evaluation.