The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jun 2024
Perioperative and oncologic outcomes of pulmonary resection for synchronous oligometastatic non-small cell lung cancer: Evidence for surgery in advanced disease.
Recent randomized trials have demonstrated a survival advantage with the use of local consolidative therapy in oligometastatic non-small cell lung cancer; however, the indications for and outcomes after pulmonary resection as a component of local consolidative therapy remain ill defined. We sought to characterize the perioperative and long-term survival outcomes among patients with resected oligometastatic non-small cell lung cancer. ⋯ Pulmonary resection as a means of maximum locoregional control in oligometastatic non-small cell lung cancer is feasible and safe, and may be associated with durable long-term survival benefits. The frequency of systemic postoperative progression highlights an urgent need to characterize perioperative and oncologic outcomes after pulmonary resection in the current era of novel systemic therapies.
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J. Thorac. Cardiovasc. Surg. · Jun 2024
Early outcomes of lung transplantation with lung allografts from COVID-19-positive donors.
Coronavirus disease 2019 (COVID-19) can be detected for extended periods of time with nucleic acid amplification test even after transmissibility becomes negligible. Lung allografts from COVID-19-positive donors have been used for transplantation in highly selected cases. This study aimed to clarify the early outcomes of lung transplantation with COVID-19-positive donors. ⋯ Carefully selected lung allografts from COVID-19-positive donors had comparable early posttransplant outcomes to lung allografts from COVID-19-negative donors.
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J. Thorac. Cardiovasc. Surg. · Jun 2024
The predictive capability of aortic stiffness index for aortic dissection among dilated ascending aortas.
We created a finite element model to predict the probability of dissection based on imaging-derived aortic stiffness and investigated the link between stiffness and wall tensile stress using our model. ⋯ Noninvasive transthoracic echocardiogram-derived aortic stiffness measurements may serve as an impactful metric toward predicting aortic dissection or quantifying dissection risk. A correlation between longitudinal stress and stiffness establishes an evidence-based link between a noninvasive stiffness parameter and stress state of the aorta with clinically apparent dissection events.
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J. Thorac. Cardiovasc. Surg. · Jun 2024
WTSA 2023: To Decline or Not To Decline: Consequences of Decision-Making Regarding Lung Offers from Donors with Hepatitis C.
Lung transplants from donors with hepatitis C (HCV D+) have excellent outcomes, but these organs continue to be declined. We evaluated whether (1) being listed to consider and (2) accepting versus declining HCV D+ offers provided a survival benefit to lung transplant candidates. ⋯ Considering HCV D+ lung offers was associated with a 17% lower risk of waitlist mortality, whereas accepting versus declining an HCV D+ lung offer was associated with a 20% lower risk of mortality. Centers and candidates should consider accepting suitable HCV D+ lung offers to optimize outcomes.
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J. Thorac. Cardiovasc. Surg. · Jun 2024
Aortic diameter is a poor predictor of aortic tissue failure metrics in patients with ascending aneurysms.
There is growing consensus that aortic diameter is a flawed predictor of aortic dissection risk. We hypothesized that aortic tissue metrics would be better predicted by clinical metrics other than aortic diameter. Our objectives were to (1) characterize circumferential aortic failure stress and stretch as a result of aortic size and patient demographics, and (2) identify the influence of bicuspid aortic valve on failure metrics. ⋯ Aneurysmal ascending aortic tissue failure metrics correlated with available clinical metrics. Greater tissue thickness, older age, and tricuspid aortic valve morphology outperformed aortic diameter, warranting further investigation into the role of a patient-specific multifactorial dissection risk assessment over aortic diameter as a sole marker of aortic tissue integrity.