The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2022
Randomized Controlled TrialSurgical outcomes after nivolumab or nivolumab with ipilimumab treatment in patients with non-small cell lung cancer.
Surgical outcomes for non-small cell lung cancer after neoadjuvant immune checkpoint inhibitors continue to be debated. We assessed perioperative outcomes of patients treated with Nivolumab or Nivolumab plus Ipilimumab (NEOSTAR) and compared them with patients treated with chemotherapy or previously untreated patients with stage I-IIIA non-small cell lung cancer. ⋯ Operating after neoadjuvant N or NI is overall safe and effective and yields perioperative outcomes similar to those achieved after chemotherapy or upfront resection.
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J. Thorac. Cardiovasc. Surg. · Nov 2022
Association of diameter and wall stresses of tricuspid aortic valve ascending thoracic aortic aneurysms.
Ascending thoracic aortic aneurysms carry a risk of acute type A dissection. Elective repair guidelines are designed around size thresholds, but the 1-dimensional parameter of maximum diameter cannot predict acute events in small aneurysms. Biomechanically, dissection can occur when wall stress exceeds strength. Patient-specific ascending thoracic aortic aneurysm wall stresses may be a better predictor of dissection. Our aim was to compare wall stresses in tricuspid aortic valve-associated ascending thoracic aortic aneurysms based on diameter. ⋯ Circumferential and longitudinal wall stresses are higher as diameter increases, but size groups had large overlap of stress ranges. Wall stress thresholds based on aneurysm wall strength may be a better predictor of patient-specific risk of dissection than diameter in small ascending thoracic aortic aneurysms.
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J. Thorac. Cardiovasc. Surg. · Nov 2022
Randomized Controlled TrialA randomized trial comparing axillary versus innominate artery cannulation for aortic arch surgery.
Cerebral protection remains the cornerstone of successful aortic surgery; however, there is no consensus as to the optimal strategy. ⋯ diffusion-weighted magnetic resonance imaging assessments indicate that antegrade cerebral protection with innominate cannulation is safe and affords similar neuroprotection to axillary cannulation during aortic surgery, although the burden of new neurological lesions is high in both groups.
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J. Thorac. Cardiovasc. Surg. · Nov 2022
Propensity score analysis in patients with and without previous isolated coronary artery bypass grafting who require proximal aortic and arch surgery.
The risk posed by previous isolated coronary artery bypass grafting (CABG) in patients who require proximal aortic or aortic arch surgery is unclear. We compared outcomes of ascending aortic and arch procedures in patients with and without previous CABG. ⋯ This is one of the largest studies yet reported to examine the impact of previous isolated CABG on proximal aortic or arch surgery outcomes. Although these results may be specific to aortic centers of excellence, in this complicated patient cohort, previous isolated CABG did not independently predict any adverse outcome. These results could serve as a benchmark for assessing future endovascular therapies.
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J. Thorac. Cardiovasc. Surg. · Nov 2022
Prepump autologous blood collection is associated with reduced intraoperative transfusions in aortic surgery with circulatory arrest: A propensity score-matched analysis.
To evaluate the effect of autologous whole blood (AWB) collection on intraoperative/postoperative allogeneic blood transfusion rate in complex aortic surgery with hypothermic circulatory arrest. ⋯ Pre-pump autologous blood collection may reduce the need for intraoperative transfusion of allogenic non-red-cell blood products in patients undergoing complex aortic surgery with hypothermic circulatory arrest. A larger study is needed to clarify the influence of this association on patient outcomes and resource utilization.