The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2024
Independent associations with early mortality after open repair of Crawford extent IV thoracoabdominal aortic aneurysms.
We aimed to identify outcomes and factors that independently associate with early mortality after open repair of Crawford extent IV thoracoabdominal aortic aneurysms, defined as aneurysms confined to the segment below the diaphragm. ⋯ Although patient comorbidities contributed to operative mortality, factors associated with the repair, such as urgent or emergency status, the duration of aortic crossclamping, and certain types of complex reoperation, also played prominent roles. Patients who survive the operation can expect a durable repair that usually is free from late reintervention. Expanding our collective knowledge regarding patients who undergo open repair of extent IV thoracoabdominal aortic aneurysms will enable clinicians to establish best practices and improve patient outcomes.
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J. Thorac. Cardiovasc. Surg. · Jul 2024
Aortic root repair in acute type A aortic dissection: Neomedia or no neomedia.
Neomedia has been frequently used for aortic root repair in acute type A aortic dissection. We aimed to determine the efficacy and necessity of neomedia during acute type A aortic dissection root repair. ⋯ In patients with acute type A aortic dissection, aortic root repair with or without neomedia was equally safe and effective. Neomedia use could be avoided in acute type A aortic dissection repair.
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J. Thorac. Cardiovasc. Surg. · Jul 2024
Quantitative Flow Ratio and Graft Outcomes of Coronary Artery Bypass Grafting Surgery: A Retrospective Study.
Quantitative flow ratio (QFR) is a novel noninvasive tool for the functional assessment of coronary stenosis. Whether or not QFR could predict graft outcomes after coronary artery bypass grafting procedure is unknown. This study aimed to investigate the association of QFR value with graft outcomes after coronary artery bypass grafting surgery. ⋯ Target vessel QFR >0.80 was associated with a significantly higher risk of arterial graft occlusion at 12 months after coronary artery bypass grafting surgery. No significant association was found between target lesion QFR and vein graft occlusion.
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J. Thorac. Cardiovasc. Surg. · Jul 2024
Rescue therapy for symptomatic spinal cord ischemia after thoracic endovascular aortic repair.
Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) can cause permanent neurologic deficits and poor long-term survival. Targeted treatment of new SCI symptoms after TEVAR (rescue therapy [RT]) might improve/resolve neurologic symptoms but few data characterize the association of specific interventions with SCI outcomes. We evaluated the effectiveness of post-TEVAR RT at our tertiary aortic center. ⋯ Permanent paraplegia from post-TEVAR SCI is rare (1.5%). Older patients with comorbidities carry greater post-TEVAR SCI risk. SCI symptoms improved/resolved with CSFD and multimodal RT in 68.9% of patients, but no intervention was independently associated with improvement. TEVAR centers should have robust protocols for timely and safe CSFD placement to augment RT strategies for SCI.
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J. Thorac. Cardiovasc. Surg. · Jul 2024
Predicting outcomes in esophageal adenocarcinoma following neoadjuvant chemoradiation: interactions between tumor response and survival.
The prognostic value of tumor regression scores (TRS) in patients with esophageal adenocarcinoma (EAC) who underwent neoadjuvant chemoradiation remains unclear. We sought to investigate the prognostic value of pathologic and metabolic treatment response among EAC patients undergoing neoadjuvant chemoradiation. ⋯ Patients with pathologic complete response had prolonged OS, whereas no difference in survival was detected among other TRS categories. At initial staging, the presence of signet ring cells and greater SUV uptake at regional lymph nodes predicted residual disease at pathology and shorter OS, suggesting the need for new treatment strategies for these patients.