The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 2023
Multicenter StudySurgical results of the Lung Cancer Mutation Consortium 3 trial: A phase II multicenter single-arm study to investigate the efficacy and safety of atezolizumab as neoadjuvant therapy in patients with stages IB-select IIIB resectable non-small cell lung cancer.
Multimodality treatment for resectable non-small cell lung cancer has long remained at a therapeutic plateau. Immune checkpoint inhibitors are highly effective in advanced non-small cell lung cancer and promising preoperatively in small clinical trials for resectable non-small cell lung cancer. This large multicenter trial tested the safety and efficacy of neoadjuvant atezolizumab and surgery. ⋯ Neoadjuvant atezolizumab in resectable stage IB to IIIB non-small cell lung cancer was well tolerated, yielded a 20% major pathological response rate, and allowed safe, complete surgical resection. These results strongly support the further development of immune checkpoint inhibitors as preoperative therapy in locally advanced non-small cell lung cancer.
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J. Thorac. Cardiovasc. Surg. · Mar 2023
Multicenter StudyPrevalence and anatomical characteristics of subsuperior segment in lung lower lobe.
The subsuperior segment is an atypical pulmonary segment of the lung lower lobe. With the increased application of segmentectomy, it has received increased attention from thoracic surgeons. Studies of the subsuperior segment are scarce and mostly on the basis of small-sample autopsy studies, whose described characteristics are inconsistent with intraoperative observations. Our objective was to accurately define the subsuperior segment and elucidate its prevalence and anatomical characteristics in detail. ⋯ Using a multicenter large-sample study, we calculated a 32.04% prevalence and systematically detailed the anatomical characteristics of the subsuperior segment in the lung lower lobe, corrected previous reports, and supplemented pulmonary anatomical studies.
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J. Thorac. Cardiovasc. Surg. · Mar 2023
Differences among sexes in presentation and outcomes in acute type A aortic dissection repair.
Female sex is a known risk factor in most cardiac surgery, including coronary and valve surgery, but unknown in acute type A aortic dissection repair. ⋯ Physicians and women should be cognizant of the risk of acute type A aortic dissection later in life in women. Surgeons should strongly consider operations for acute type A aortic dissection in women, especially in patients aged 70 years or more.
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J. Thorac. Cardiovasc. Surg. · Mar 2023
Acellular biomaterial modulates myocardial inflammation and promotes endogenous mechanisms of postinfarct cardiac repair.
After myocardial infarction, we previously showed that epicardial implantation of porcine small intestinal submucosal extracellular matrix (SIS-ECM) improves postinfarct cardiac function through fibroblast-mediated angiogenic and antifibrotic pathways. Herein, we characterize how SIS-ECM also coordinates a reparative cardiac inflammatory response. ⋯ SIS-ECM promotes engraftment by native fibroblasts and leukocytes, and modulates fibroblast activity via fibroblast growth factor 2 and toll-like receptor 9 to potentiate a proangiogenic inflammatory response. Subsequently, the material increases myocardial counts of reparative proangiogenic leukocytes that can induce neovascularization. This reparative inflammatory response may explain previously reported functional improvements. Fibroblast growth factor 2 and toll-like receptor 9 mechanisms can be leveraged to design next-generation materials for postinfarct cardiac repair.
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J. Thorac. Cardiovasc. Surg. · Mar 2023
Multicenter StudyA bridge-to-bridge approach to heart transplantation using extracorporeal membrane oxygenation and total artificial heart.
This study aims to describe the outcomes after heart transplantation using a bridge-to-bridge strategy with a sequence of extracorporeal membrane oxygenation (ECMO) support followed by temporary total artificial heart implantation (TAH-t). ⋯ Sequential bridging from ECMO to TAH-t followed by heart transplantation is a viable option for a group of highly selected patients.