The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2022
Mapping the collateral network: Optimal near-infrared spectroscopy optode placement.
Paraplegia after extensive aortic procedures is a disastrous complication, and maintenance of adequate spinal cord perfusion/oxygenation is pivotal to its prevention. Collateral network (CN) near-infrared spectroscopy (cnNIRS) has been introduced as a noninvasive method for indirect spinal cord oxygenation monitoring. However, the CN has not been investigated in its entirety using this monitoring modality. This study aimed to identify the optimal cnNIRS positioning in an acute large animal model for routine clinical use. ⋯ cnNIRS is capable of detecting relevant changes during ischemia and reperfusion from the mid-thoracic level downward with characteristic oxygenation patterns corresponding to CN and spinal cord regional perfusion. For extensive aortic procedures, noninvasive cnNIRS placement appears to be useful from the mid-thoracic level (T7-T9) to the lower lumbar level (L3-L5) and also may serve as a versatile monitoring method for procedures limited to the proximal thoracic aorta.
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J. Thorac. Cardiovasc. Surg. · Jul 2022
ReviewReoperation to correct unsuccessful vascular ring and vascular decompression surgery.
Although most children do well after operations to relieve vascular compression of the esophagus and airway, many will have persistent/recurrent symptoms. We review our surgical experience using a customized approach to correct various etiologies of failure after vascular ring/decompression surgery. ⋯ Persistent/recurrent symptoms after release of vascular compression are frequently caused by 5 different etiologies. A multidisciplinary strategy for workup and a customized operative approach can effectively treat these cases and may suggest opportunity at the index surgery to prevent reoperation and achieve optimal outcomes.
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J. Thorac. Cardiovasc. Surg. · Jul 2022
Erector spinae muscle radiographic density is associated with survival after lung transplantation.
The study objective was to verify whether low preoperative radiographic density of erector spinae muscles is associated with poor prognosis after lung transplantation. ⋯ Low mean radiographic density of the erector spinae muscles was closely associated with a poor prognosis after lung transplantation. The prognosis was particularly poor in patients with preoperative steroid use and a low mean radiographic density of the erector spinae muscles. These results may be useful when considering the indications for lung transplantation or preoperative interventions. VIDEO ABSTRACT.
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J. Thorac. Cardiovasc. Surg. · Jul 2022
Multicenter StudyThe role of virtual-assisted lung mapping 2.0 combining microcoils and dye marks in deep lung resection.
Virtual-assisted lung mapping 2.0 is a novel preoperative bronchoscopic lung mapping technique combining the multiple dye marks of conventional virtual-assisted lung mapping with intrabronchial microcoils to navigate thoracoscopic deep lung resection. This study's purpose was to evaluate the feasibility of virtual-assisted lung mapping 2.0 in resecting deeply located pulmonary nodules with adequate margins. ⋯ This study demonstrated that virtual-assisted lung mapping 2.0 can facilitate successful resections for deep pulmonary nodules, overcoming the limitations of conventional virtual-assisted lung mapping.
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J. Thorac. Cardiovasc. Surg. · Jul 2022
Neighborhood socioeconomic status is associated with differences in operative management and long-term survival after coronary artery bypass grafting.
We sought to characterize differences in operative management and surgical outcomes after coronary artery bypass grafting associated with the socioeconomic context in which a patient lives. ⋯ The socioeconomic context in which a patient lives is significantly associated with short- and long-term outcomes after coronary artery bypass grafting. There may also be variation in operative management, demonstrated by decreased use of arterial conduits. Lower rates of arterial revascularization among socioeconomically disadvantaged patients who undergo coronary artery revascularization may provide a target for intervention.