The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest.
Surgical and cerebral protection strategies in aortic arch surgery remain under debate. Perioperative results using deep hypothermic circulatory arrest (DHCA) have been associated with favorable short-term mortality and stroke rates. The present study focuses on late survival in patients undergoing aortic surgery using DHCA. ⋯ Aortic surgery with DHCA can be performed with favorable late survival, with the duration of DHCA period having only a limited impact. However, these results cannot be generalized for very long durations of DHCA (>50 minutes), when perfusion methods may be preferable. In elective, nondissection first-time surgeries, a late survival comparable to that in a reference population can be achieved. Early survival is adversely affected by aortic dissection, redo status, and disease extent.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Diaphragmatic fenestration for refractory chylothorax after congenital cardiac surgery in infants.
Medically refractory chylous pleural effusion after congenital heart surgery is associated with significant morbidity and mortality, especially in infants. We reviewed our experience with diaphragmatic fenestration procedure in this group of patients. ⋯ Diaphragmatic fenestration is an effective and safe strategy for management of persistent chylous effusions after congenital cardiac surgery.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Staged treatment of mega aortic syndrome using the frozen elephant trunk and hybrid thoracoabdominal repair.
We report our experience with a staged hybrid approach for the treatment of extended aortic disease, also known as "mega aortic syndrome." ⋯ The concept of a staged hybrid repair of the mega aortic syndrome is technically feasible. The frozen elephant trunk technique represents an attractive treatment option, offering an adequate landing zone for later thoracoabdominal repair in patients with extended aortic disease. For completion of the repair, a staged hybrid approach with renovisceral debranching and aneurysm exclusion using off-the-shelf stent grafts shows promising results with low surgical morbidity and mortality.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Prognostic impact of a ground glass opacity component in the clinical T classification of non-small cell lung cancer.
To determine whether solid component size and the presence of a ground glass opacity (GGO) component are independently associated with survival outcomes in patients with early-stage non-small cell lung cancer (NSCLC) using the eighth edition Lung Cancer Stage Classification. ⋯ The presence of a GGO component is a significant prognostic factor in early-stage NSCLC. External validation is required to assess whether it should be adopted as a novel factor in clinical T staging.
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J. Thorac. Cardiovasc. Surg. · Dec 2017
Pseudoaneurysm complicating right ventricle-to-pulmonary artery conduit surgery: Incidence and risk factors.
Although pseudoaneurysm is an uncommon complication after right ventricle-to-pulmonary artery conduit placement, it has the potential to cause significant morbidity and mortality. ⋯ This study is unique in identifying both patient and surgical factors that may predispose to pseudoaneurysm development and can help inform optimal strategies to monitor and evaluate this patient population.