The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2021
ReviewTranscatheter mitral valve repair for functional mitral regurgitation: Evaluating the evidence.
Two trials (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation Trial and Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation Trial) were published in 2018 evaluating the effectiveness and safety of transcatheter repair for patients with heart failure with significant functional mitral regurgitation, which yielded different results. This article reviews the strength of the evidence, differences in trial designs, ethical and implementation implications, and delineates future research needs to help guide the appropriate dissemination of transcatheter repair for functional patients with mitral regurgitation. ⋯ Given the discordance observed between trials, ongoing innovation in patient management, and potential expansion of indications for use, the evidence base must be expanded to optimize appropriate implementation of this complex therapy. This will require more complete capture of outcome data in real-world settings for all eligible candidates whether or not they receive this therapy. Inevitably, the indications for use of this therapy will expand, as will the devices and therapeutic approaches for this population, necessitating the study of comparative effectiveness through randomized trials or observational studies. Moreover, given the substantial variations in care delivery, conducting implementation research to delineate characteristics of the optimal care model would be of benefit.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Observational StudyThe impact of additional antegrade pulmonary blood flow at bidirectional Glenn shunt on long-term outcomes.
We investigated the impact of additional antegrade pulmonary blood flow on the long-term outcomes after bidirectional Glenn shunt. ⋯ Maintaining antegrade pulmonary blood flow at bidirectional Glenn shunt was beneficial for higher oxygen saturation and larger pulmonary artery size before Fontan operation. However, it was unfavorable for overall transplant-free survival with a sustained higher risk of death or transplant until the elimination of antegrade pulmonary blood flow.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Observational StudyMorphological and functional reserves of the right middle lobe: Radiological analysis of changes after right lower lobectomy in healthy individuals.
Remaining lung tissue after pulmonary resection can expand without decline in structural complexity and compensate for functional loss, showing morphological and functional reserves. However, the distribution of these reserves is unknown. This study examined the heterogeneity of morphological and functional reserves of the remaining lung tissue. ⋯ Morphological and functional changes in lung tissue remaining after pulmonary resection were heterogeneous. The right middle lobe demonstrated morphological and functional reserves after right lower lobectomy.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Multicenter Study Observational StudyImpact of perioperative course during cardiac surgery on outcomes in patients 80 years and older.
To describe the associations among preoperative characteristics, intraoperative and postoperative factors, and mortality and morbidity after open-heart surgery in patients age ≥80 years. ⋯ Our findings emphasize the importance of careful referral regarding the procedural burden for very elderly patients and may provide support for informed patient discussions about prognosis and recovery.