The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Is the practice of using oversized organs for recipients with elevated pulmonary vascular resistance justified?
The purpose of this study was to assess post-transplantation outcomes in recipients with increased pulmonary vascular resistance (PVR) in relation to donor size. ⋯ Despite a persistent practice pattern to transplant oversized organs in high-PVR patients, there remains no difference in post-transplantation survival among these patients and those who received smaller organ transplants. Therefore, transplants in patients with high PVR should not be delayed by waiting for larger donors.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Aortic regurgitation provokes phenotypic modulation of smooth muscle cells in the normal ascending aorta.
Aortic complications are more likely to occur in patients with ascending aortic aneurysms and concomitant aortic regurgitation (AR). AR may have a negative influence on the aortic wall structure even in patients with tricuspid aortic valves and absence of aortic dilatation. It is unknown whether smooth muscle cell (SMC) changes are a feature of AR-associated aortic remodeling. ⋯ AR itself negatively influences SMC phenotype in the ascending aortic wall. This AR-specific effect is independent of aortic diameter and aortic valve morphology, although it is more pronounced with bicuspid aortic valves. These findings provide insight into the mechanisms of AR-related aortic remodeling, and they provide a model for studying SMC-specific therapies in culture.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Papillary Muscle Approximation in Chronic Ovine Functional Tricuspid Regurgitation.
Isolated tricuspid ring annuloplasty remains the surgical standard for functional tricuspid regurgitation repair but offers suboptimal results when right ventricular dilation and remodeling along with papillary muscle displacement is present. Addressing subvalvular remodeling with papillary muscle approximation may improve clinical outcomes. ⋯ Papillary muscle approximations were effective in reducing severe ovine functional tricuspid regurgitation associated with right ventricular dilation and papillary muscle displacement. Further studies are needed to evaluate efficacy of this adjunct to ring annuloplasty in repair of severe functional tricuspid regurgitation.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Lobectomy Versus Proton Therapy for Stage I Non-small Cell Lung Cancer.
Lobectomy is the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). In recent years, an increasing number of patients with lung cancer have been treated using proton therapy (PT). We conducted a propensity score-matched analysis to compare the treatment outcomes of these 2 modalities. ⋯ We found no difference in survival or disease control between lobectomy and PT in patients with histologically confirmed clinical stage I NSCLC. Despite these findings, the potential for unmeasured confounding factors remains, and randomized control trials are needed to better compare these treatment modalities.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Statistical power and sample size calculations for time-to-event analysis.
To provide thoracic and cardiovascular surgeons with the necessary tools for performing sample size and power calculations for studies with time-to-event outcomes. ⋯ Statistical power is an essential element for designing studies to ensure sufficient sample sizes for detecting treatment effects or group differences in time-to-event patient outcomes. Power and sample size justification not only adds statistical rigor and credibility to research manuscripts, but also provides the reader with assurance that the findings and conclusions are valid and based on a sufficient number of patients.