The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2020
Persistence of risk of death after hospital discharge to locations other than home after cardiac surgery.
Temporal changes in the risk of postoperative death following cardiac surgery are uncharacterized. We aimed to quantify the duration of postoperative phase with elevated risk of death in patients who underwent cardiac surgery and were discharged to home and destinations other than home. ⋯ Hospital discharges to locations other than home following cardiac surgery were associated with an increased risk of late mortality. The postoperative high-risk phase persisted for 80 days in patients who were discharged to locations other than home, supporting the use of 90-day outcome measures as quality metrics. Predictors of discharge to locations other than home were identified, and this may aid in selective intervention to reduce the risk of death in this vulnerable patient population.
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J. Thorac. Cardiovasc. Surg. · Feb 2020
Long-term, disease-specific outcomes of thymic malignancies presenting with de novo pleural metastasis.
Treatment of patients with thymic malignancies metastatic to the pleura or pericardium is challenging, and benefits of aggressive treatment are unclear. We sought to characterize the long-term outcomes in this population. ⋯ Prolonged survival and, in some cases, cure can be achieved in patients with thymic malignancies metastatic to the pleura or pericardium. Aggressive multimodality therapy may be appropriate for select patients.
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J. Thorac. Cardiovasc. Surg. · Feb 2020
Outcomes of the arterial switch operation in patients with aortic arch obstruction.
Transposition of the great arteries or Taussig-Bing anomaly with concomitant aortic arch obstruction is uncommon, with limited data on long-term outcomes after arterial switch operation and aortic arch obstruction repair. This study sought to determine outcomes of patients undergoing arterial switch operation and aortic arch obstruction repair at a single institution. ⋯ Patients with transposition of the great arteries or Taussig-Bing anomaly with associated aortic arch obstruction have a higher reintervention rate, especially for right-sided obstruction. Closer monitoring of this subgroup of patients is warranted.
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J. Thorac. Cardiovasc. Surg. · Feb 2020
Flow disturbances and the development of endocardial fibroelastosis.
Endothelial-to-mesenchymal transition (EndMT) has been identified as the underlying mechanism of endocardial fibroelastosis (EFE) formation. The purpose of this study was to determine whether hemodynamic alterations due to valvar defects promote EndMT and whether age-specific structural changes affect ventricular diastolic compliance despite extensive surgical resection of EFE tissue. ⋯ Patients with and without HLHS with flow disturbances due to stenotic or incompetent valves develop EndMT-derived fibrotic tissue covering the LV. When EFE recurs, it is directly associated with flow disturbances and switches to an infiltrative growth pattern with increasing age, leading to increased diastolic stiffness of the LV.
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J. Thorac. Cardiovasc. Surg. · Feb 2020
Longitudinal functional health status in young adults with repaired dextro-transposition of the great arteries: A Congenital Heart Surgeons' Society study.
Improved survival has led to interest in functional health status (FHS) as patients with dextro-transposition of the great arteries (d-TGA) transition to adulthood. Our primary objectives were (1) evaluation of The Medical Outcomes Study Short Form-36 Health Survey (SF-36) results; (2) comparison with results of patients who completed the Child Health Questionnaire-Child Form 87 (CHQ-CF87) previously, or the PedsQL Generic Core Scales (PedsQL) survey subsequently; and (3) determination of factors associated with SF-36 domains. ⋯ Patients with d-TGA surviving into adulthood, regardless of morphology or repair type, can primarily expect normal FHS. Addressing the challenges of patients with d-TGA entering adulthood requires consideration of psychosocial factors and clinical management.