The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Multicenter Study Observational StudyThe Importance of Timing in Post-Cardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: a Descriptive Multicenter Observational Study.
Postcardiotomy extracorporeal membrane oxygenation (ECMO) can be initiated intraoperatively or postoperatively based on indications, settings, patient profile, and conditions. The topic of implantation timing only recently gained attention from the clinical community. We compare patient characteristics as well as in-hospital and long-term survival between intraoperative and postoperative ECMO. ⋯ Intraoperative and postoperative ECMO implantations are associated with different patient characteristics and outcomes, with greater complications and in-hospital mortality after postoperative ECMO. Strategies to identify the optimal location and timing of postcardiotomy ECMO in relation to specific patient characteristics are warranted to optimize in-hospital outcomes.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Aortic Area/Height Ratio, Peak Wall Stresses, and Outcomes in Veterans with Tricuspid vs Bicuspid Aortic Valve Associated Ascending Thoracic Aortic Aneurysms.
In ascending thoracic aortic aneurysm risk stratification, aortic area/height ratio is a reasonable alternative to maximum diameter. Biomechanically, aortic dissection may be initiated by wall stress exceeding wall strength. Our objective was to evaluate the association between aortic area/height and peak aneurysm wall stresses in relation to valve morphology and 3-year all-cause mortality. ⋯ Area/height was more predictive of high circumferential stresses in bicuspid than tricuspid valve aneurysms, but similarly less predictive of high longitudinal stresses in both valve types. Peak longitudinal stress, not area/height, independently predicted all-cause mortality. VIDEO ABSTRACT.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Observational StudyLong-term Echocardiographic Data, Mechanisms of Failure and Reintervention Outcomes of the Epic™ Valve in Mitral Position - A Large Observational Cohort.
Long-term echocardiographic reports on mitral valve (MV) porcine xenograft bioprosthesis (Epic) are lacking, and postreintervention outcomes of failed Epic are unknown. We aimed to assess the mechanisms and independent predictors of Epic failures and to compare short- and mid-term outcomes according to reintervention type. ⋯ The Epic Mitral valve has stable hemodynamics through 5 years and is associated with low incidence of SVD and reintervention, mostly due to endocarditis and leaflet tear without calcification. Reintervention type had no influence on early outcomes and mid-term mortality.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Machine learning for dynamic and early prediction of acute kidney injury after cardiac surgery.
Acute kidney injury after cardiac surgery increases morbidity and mortality. Diagnosis relies on oliguria or increased serum creatinine, which develop 48 to 72 hours after injury. We hypothesized machine learning incorporating preoperative, operative, and intensive care unit data could dynamically predict acute kidney injury before conventional identification. ⋯ Ensemble machine learning models using electronic medical records data can dynamically predict acute kidney injury risk after cardiac surgery. Continuous postoperative risk assessment could facilitate interventions to limit or prevent renal injury.
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J. Thorac. Cardiovasc. Surg. · Dec 2023
Prognostic value of KRAS G12C mutation in lung adenocarcinoma stratified by stages and radiological features.
The role of KRAS G12C is of particular interest given the promising clinical activity of KRAS G12C-specific inhibitors. This study comprehensively investigated the clinicopathological characteristics and prognostic value of KRAS G12C mutation in patients with surgically resected lung adenocarcinoma. ⋯ The KRAS G12C mutation had a significant prognostic value in stage I lung adenocarcinomas as well as in part-solid tumors. Furthermore, it exhibited a potentially aggressive phenotype associated with early and locoregional recurrence. These findings might be relevant as better KRAS treatments are developed for clinical application.