The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Observational StudyStent-assisted balloon dilatation of chronic aortic dissection.
The treatment of complicated chronic aortic dissection remains controversial. We previously reported encouraging early results with the stent-assisted balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) technique for treating complicated acute aortic dissections. However, to date there have been no specific reports on the treatment of complicated chronic aortic dissections with this technique. The aim of this study was to assess the results of the STABILISE technique to treat complicated chronic aortic dissection. ⋯ The STABILISE technique is a safe and effective means of performing immediate, complete aortic remodeling of the thoracoabdominal aorta in patients with complicated chronic aortic dissection, stabilizing the diameter of the dissected aorta.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Comparative StudyWall stress analyses in patients with ≥5 cm versus <5 cm ascending thoracic aortic aneurysm.
Current guidelines for elective surgery of ascending thoracic aortic aneurysms (aTAAs) use aneurysm size as primary determinant for risk stratification of adverse events. Biomechanically, dissection may occur when wall stress exceeds wall strength. Determining patient-specific aTAA wall stresses by finite element analysis can potentially predict patient-specific risk of dissection. This study compared peak wall stresses in patients with ≥5.0 cm versus <5.0 cm aTAAs to determine correlation between diameter and wall stress. ⋯ Peak patient-specific aTAA wall stresses overall were larger for ≥5.0 cm than aTAA <5.0 cm. Although some correlation between size and peak wall stresses was found in aTAA ≥5.0 cm, poor correlation existed between size and peak wall stresses in aTAA <5.0 cm. Patient-specific wall stresses are particularly important in determining patient-specific risk of dissection for aTAA <5.0 cm.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Esophageal adenocarcinoma with any component of signet ring cells portends poor prognosis and response to neoadjuvant therapy.
Multiple investigations have shown inferior outcomes for esophageal cancer patients with signet ring cell (SRC) histology. Traditionally, SRC adenocarcinoma has been defined by ≥50% of the tumor composed of SRC. We hypothesized that patients with SRC even <50% would show resistance to standard multimodality therapy with poorer long-term outcomes. ⋯ We present the only known evaluation of the percentage of SRC component in esophageal carcinoma. Our data support the hypothesis that esophageal adenocarcinoma with any component of SRC are more resistant to chemoradiation with poorer survival. Pathologic reporting of esophageal adenocarcinoma should include any component of SRC. Alternative therapies in patients with any SRC component may be indicated.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Repeated anatomical pulmonary resection for metachronous ipsilateral second non-small cell lung cancer.
We investigated the surgical outcomes of repeated pulmonary resection for metachronous ipsilateral second non-small cell lung cancer (NSCLC). ⋯ Reanatomical pulmonary resection showed acceptable oncologic outcomes for metachronous ipsilateral second NSCLC. The non-CP procedure was technically challenging; however, both oncologic and surgical results were feasible compared with the CP. This procedure might be a promising novel strategy for properly selected ipsilateral second NSCLC.
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J. Thorac. Cardiovasc. Surg. · Nov 2021
Outcomes of pulmonary valve leaflet augmentation for transannular repair of tetralogy of Fallot.
To evaluate the midterm results of pulmonary valve leaflet augmentation in transannular repair of tetralogy of Fallot (TOF). ⋯ At midterm follow-up of transannular repair with pulmonary valve leaflet augmentation, severe PR occurs in less than 50% of patients. The expanded polytetrafluoroethylene patch performs better than pericardium.