The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Comparative StudyChronic thromboembolic pulmonary hypertension in Austria and Japan.
Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by one or more of the following features: intraluminal thrombus organization, fibrous stenosis, and complete obliteration of major pulmonary arteries, amenable to significant improvement by pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty, and medical treatments with vasodilators. Because treatment practices and outcomes differ in Europe versus Japan, we hypothesized that population-based characteristics of pulmonary vascular phenotypes may exist in Austria compared with Japan. The objectives of this study were to analyze clinical characteristics, hemodynamics, and PEA specimens in consecutive patients with CTEPH undergoing PEA in Austria and Japan. ⋯ This study documents an inflammatory thrombotic phenotype in Austrian compared with Japanese patients with CTEPH that may be a determinant of differential treatment outcomes.
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Perioperative chemotherapy is not associated with improved survival in stage I pleomorphic lung cancer.
Pulmonary pleomorphic carcinoma represents an understudied, rare, and aggressive histologic subtype of non-small cell lung cancer. Better understanding of rare disease subtypes allows for improved individualization of patient care. This study aimed to evaluate current trends in treatment and survival of pleomorphic carcinoma. ⋯ Pulmonary pleomorphic carcinoma is rare and aggressive, with worse survival when compared with adenocarcinoma. Perioperative chemotherapy has not demonstrated significant survival benefits in stage I pleomorphic cancer.
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J. Thorac. Cardiovasc. Surg. · Aug 2019
In-hospital mortality in older patients after ventricular assist device implantation: A national cohort study.
To assess baseline patient characteristics and identify factors associated with in-hospital mortality after ventricular assist device (VAD) placement. ⋯ Older patients who underwent 1 or more intensive treatments before VAD placement had a nearly 50% inpatient mortality and were unlikely to receive a cardiac transplantation. Refining patient selection might help better align VAD with those most likely to benefit.
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Untreated distal intimal tears may be associated with paraplegia after total arch replacement and frozen elephant trunk treatment of acute Stanford type A aortic dissection.
To investigate the possible overlooked causes of early postoperative paraplegia, a severe complication of acute Stanford type A aortic dissection (ATAAD) after total arch replacement and frozen elephant trunk (FET). ⋯ Total arch replacement and FET is safe and feasible for ATAAD involving the descending aorta. Early postoperative paraplegia is associated with the "cutoff" phenomenon in the lower descending aorta. The position of the first untreated intimal tear may be related with the occurrence of the "cutoff" phenomenon and paraplegia.
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J. Thorac. Cardiovasc. Surg. · Aug 2019
Repeat aortic valve replacement for failing aortic root homograft.
Published data are limited in comparison of transcatheter aortic valve replacement with surgical aortic valve replacement for the failing aortic root homograft. We reviewed our experience with repeat aortic valve replacement in failing aortic root homografts to compare outcomes of transcatheter aortic valve replacement and surgical aortic valve replacement. ⋯ Repeat aortic valve replacement for failing aortic root homograft is associated with notable risk of morbidity and mortality regardless of replacement technique. Avoidance of vascular injury could lead to improved outcomes in the transcatheter aortic valve replacement group.