The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2021
Recurrent aortic insufficiency after emergency surgery for acute type A aortic dissection with aortic root preservation.
Patients with acute type A aortic dissection demonstrate a wide range of aortic insufficiency. Outcomes after valve resuspension and root repair are not well studied in the long term. We evaluated the long-term effects of preoperative aortic insufficiency in patients undergoing emergency root-preserving surgery for acute type A aortic dissection. ⋯ Preoperative aortic insufficiency is an important predictor of recurrent aortic insufficiency in patients undergoing valve resuspension with root reconstruction for emergency acute type A aortic dissection repair. Increased echocardiographic surveillance for recurrent aortic insufficiency may be warranted in this cohort.
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J. Thorac. Cardiovasc. Surg. · Jun 2021
Timing of coronary artery bypass grafting after acute myocardial infarction may not influence mortality and readmissions.
Coronary artery bypass grafting is often delayed after acute myocardial infarction to avoid an increase in postoperative morbidity and mortality. We hypothesized that the timing of coronary artery bypass grafting after acute myocardial infarction may not be consistently associated with postoperative outcomes. ⋯ After adjusting for baseline patient characteristics, there was no statistically significant difference between timing cohorts for mortality or major adverse cardiovascular and cerebrovascular event readmissions.
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J. Thorac. Cardiovasc. Surg. · Jun 2021
Using machine learning to predict early readmission following esophagectomy.
To establish a machine learning (ML)-based prediction model for readmission within 30 days (early readmission or early readmission) of patients based on their profile at index hospitalization for esophagectomy. ⋯ We identified risk factors for early readmission after esophagectomy and introduced ML-based techniques to predict early readmission in 2 different settings: clinical decision making and quality review. ML techniques can be utilized to provide targeted support and standardize quality measures.
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J. Thorac. Cardiovasc. Surg. · Jun 2021
Non-small cell lung cancer in never- and ever-smokers: Is it the same disease?
To investigate differences in presentation, pathology, and outcomes after resection of non-small cell lung cancer (NSCLC) in never-smokers versus ever-smokers. ⋯ NSCLC in never-smokers affects women more than men and presents with different anatomic and histopathological distributions. Matched never-smokers have better or equivalent outcomes than ever-smokers in pathological stage I cancer, but are less likely to survive and to be cured of cancer as tumor burden increases. These findings suggest that there might be unique tumor or host behaviors differentially impacting survival of never- and ever-smoking patients with NSCLC.
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J. Thorac. Cardiovasc. Surg. · Jun 2021
Inhaled nitric oxide reduces injury and microglia activation in porcine hippocampus after deep hypothermic circulatory arrest.
Dysregulation of local nitric oxide (NO) synthetases occurs during ischemia and reperfusion associated with cardiopulmonary bypass, deep hypothermic circulatory arrest (DHCA), and reperfusion. Rapid fluctuations in local NO occurring in neonates and infants probably contribute to inflammation-induced microglial activation and neuronal degeneration after these procedures, eventually impairing neurodevelopment. We evaluated the anti-inflammatory efficacy of inhaled NO (iNO) in a piglet model emulating conditions during pediatric open-heart surgery with DHCA. ⋯ Using DHCA for 30 minutes, consistent with clinical exposure, we noted that iNO reduces neuronal degeneration in the hippocampus. In addition, iNO reduces microglial activation in the hippocampus after DHCA. The data suggest that iNO reduces neuronal degeneration by ameliorating inflammation and may be a practical mode of neuroprotection for infants undergoing DHCA.