The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Complication Rates Rise with Age and Haller Index in Minimal Invasive Correction of Pectus Excavatum: A High-volume Single-centre Retrospective Cohort Study.
The study objectives were to describe the compounded complication rate of minimally invasive repair of pectus excavatum, identify predisposing risk factors, and evaluate the optimal timing of correction. Minimally invasive repair of pectus excavatum is the standard treatment for pectus excavatum and consists of 2 invasive procedures, for example, correction with bar insertion followed by bar removal after 2 to 3 years. ⋯ Minimally invasive repair of pectus excavatum is associated with a high compounded complication rate that increases exponentially with age and high Haller Index. Consequently, we recommend repair during late childhood and early adolescence, and emphasize the importance of informing patients and relatives about the significant risks of adult correction as well as the need of 2 consecutive procedures taking the complication profile into account before planning surgery.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Preoperative Predictors of Spread Through Air Spaces (STAS) in Lung Cancer.
Spread through air spaces (STAS) is a new histologic feature of invasion of non-small cell lung cancer that lacks sensitivity and specificity on frozen sections and is associated with higher recurrence and worse survival with sublobar resections. Our objective is to identify preoperative characteristics that are predictive of STAS to guide operative decisions. ⋯ Young age (50 years or younger), larger (≥2 cm) solid tumors, high maximum standardized uptake values, and presence of KRAS mutation, are risk factors for STAS and can be considered for lobectomy. Smoking status and gender are still controversial risk factors for STAS.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Diagnosis and Surgical Management of Pericardial Constriction after Cardiac Surgery.
Previous cardiac surgery is an increasingly common etiology of constrictive pericarditis, but there is a paucity of data on clinical presentation and outcome of surgical treatment. ⋯ Pericardial constriction after cardiac surgery can present at any interval postoperatively. Symptoms and signs of right heart failure in patients with previous cardiac surgery should alert physicians to the possibility of pericardial constriction followed by a correct diagnosis. Pericardiectomy performed urgently following cardiac operation has poor long-term outcomes.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Digital Spatial Profiling to Predict Recurrence in Grade 3 Stage I Lung Adenocarcinoma.
Early-stage lung adenocarcinoma is treated with local therapy alone, although patients with grade 3 stage I lung adenocarcinoma have a 50% 5-year recurrence rate. Our objective is to determine if analysis of the tumor microenvironment can create a predictive model for recurrence. ⋯ Genomic difference in lung adenocarcinoma may be able to predict risk of recurrence. After further validation, stratifying patients by this risk may help guide who will benefit from adjuvant therapy.
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J. Thorac. Cardiovasc. Surg. · Sep 2024
Optimizing Care of Cardiac Surgery Patients using a Digital Platform and a Multidisciplinary Team Approach.
Restrictions to care access during the pandemic along with the increasing complexity of patients awaiting cardiac surgery provides unique challenges for care delivery. The University of Ottawa Heart Institute has developed a novel multidisciplinary digital platform, the Prehab Automated Follow-Up (AFU) Program, which delivers patient/caregiver teaching regarding risk factor mitigation, tracks patient symptoms, and screens for optimization using best practice guidelines. This study was conducted to quantify patient outcomes following initiation of the AFU Program. ⋯ Our cardiac surgery AFU Program reduced adverse health outcomes for patients by identifying and optimizing risk factors that increased quality of patient care. The AFU Program provides patient/caregiver engagement through educational support and multidisciplinary team counseling.