The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2019
Comparative StudyInvasive mediastinal staging for resected non-small cell lung cancer in a population-based cohort.
Invasive mediastinal nodal staging is recommended before curative-intent resection in patients with non-small cell lung cancer deemed at risk for mediastinal lymph node involvement. We evaluated the use and survival effect of preoperative invasive mediastinal nodal staging in a population-based non-small cell lung cancer cohort. ⋯ More than a decade after the 2001 American College of Surgeons Patient Care Evaluation report, preoperative invasive nodal staging remains underused and of variable quality, but was associated with survival benefit in high-risk patients.
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J. Thorac. Cardiovasc. Surg. · Oct 2019
Histopathology of the right ventricular outflow tract and the relation to hemodynamics in patients with repaired tetralogy of Fallot.
To evaluate the relationship between myocardial histopathology and tissue Doppler imaging (TDI) variables of the right ventricle and postoperative peak systolic right-to-left ventricular pressure ratio (Prv/Plv) in patients undergoing intracardiac repair for tetralogy of Fallot (TOF). ⋯ The great majority of myocardial tissues in cyanotic TOF indicate pre-existing hypertrophic, degenerative, and fibrotic changes. Perivascular fibrosis affects the diastolic compliance of the right ventricle and may account for the absence of improvement of late diastolic relaxation (a') and greater postoperative Prv/Plv in the absence of a residual surgical lesion.
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J. Thorac. Cardiovasc. Surg. · Oct 2019
Concomitant valve procedures in patients undergoing continuous-flow left ventricular assist device implantation: A single-center experience.
Long-term support with continuous-flow left ventricular assist devices (CF-LVADs) has improved the outcomes of patients with end-stage heart failure. However, valve disease management in patients who undergo CF-LVAD implantation remains controversial. The aim of this study was to assess our single-center experience with patients who underwent a concomitant valve procedure during implantation of a CF-LVAD. ⋯ In our experience, performing a concomitant valve procedure during CF-LVAD implantation was not associated with an increased mortality rate. The decision to perform a concomitant valve procedure should be made primarily on the basis of clinical indications for the procedure.
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J. Thorac. Cardiovasc. Surg. · Oct 2019
Aortic root replacement with stentless xenografts in patients with aortic stenosis.
Stentless bioprosthetic valves such as the Freestyle conduit have been widely used as an option for aortic root replacement in the setting of aortic root aneurysms with acceptable long-term outcomes. However, there is a paucity of data regarding the use of the Freestyle prosthesis in patients with aortic stenosis. ⋯ Aortic root replacement using Freestyle bioprostheses is a viable option for patients with severe aortic stenosis with low risk of hospital readmission for heart failure.
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J. Thorac. Cardiovasc. Surg. · Oct 2019
Comparative StudyIn the endovascular era, is elective open aortic arch surgery in elderly patients still justified?
The data supporting performing elective aortic arch surgery in patients aged 75 years or older are equivocal. We evaluated short- and long-term outcomes after elective arch surgery in patients aged ≥75 years to determine whether complex arch operations are justified in such patients. ⋯ As endovascular technology evolves, having benchmark data from likely endovascular-therapy candidates is critical. This study, among the few to focus on elective aortic arch surgery in elderly patients, suggests that surgical intervention carries risk and that novel endovascular therapies are needed.