The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2022
The role of flow stasis in transcatheter aortic valve leaflet thrombosis.
With the recent expanded indication for transcatheter aortic valve replacement to low-risk surgical patients, thrombus formation in the neosinus is of particular interest due to concerns of reduced leaflet motion and long-term transcatheter heart valve durability. Although flow stasis likely plays a role, a direct connection between neosinus flow stasis and thrombus severity is yet to be established. ⋯ This is the first patient-specific study correlating flow stasis with thrombus volume in the neosinus post-transcatheter aortic valve replacement across multiple valve types and sizes. Neosinus-specific factors create hemodynamic and thrombotic variability within individual patients. Measurement of neosinus flow stasis may guide strategies to improve outcomes in transcatheter aortic valve replacement.
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J. Thorac. Cardiovasc. Surg. · Sep 2022
Why the categorization of indexed effective orifice area is not justified for the classification of prosthesis-patient mismatch.
Although the impact of prosthesis-patient mismatch (PPM) on survival has been widely studied, there has been little debate about whether the current definition of PPM truly reflects hemodynamic obstruction. This study aimed to validate the categorization of indexed effective orifice area (EOAi) for the classification of PPM. ⋯ The use of EOAi thresholds to classify patients with PPM is undermined by a less-pronounced exponential relationship between EOAi and mean aortic gradient than previously demonstrated. Moreover, recent adjustment for obesity in the definition of PPM is not supported by these data.
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J. Thorac. Cardiovasc. Surg. · Sep 2022
Endoscopic pyloromyotomy is feasible and effective in improving post-lung transplant gastroparesis.
Gastroparesis is a debilitating and difficult to manage problem that has been reported in 20% to 90% of lung and heart-lung transplant recipients. The primary objective was to evaluate the safety and clinical effectiveness of per-oral endoscopic pyloromyotomy in relieving gastroparesis after lung transplant. Secondary objectives evaluated the effect of per-oral endoscopic pyloromyotomy on gastroesophageal reflux and allograft function. ⋯ The improvements in symptom score and radionuclide imaging observed in this uncontrolled study suggest that per-oral endoscopic pyloromyotomy is an effective strategy in the lung transplant population and can be performed with minimal morbidity.
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J. Thorac. Cardiovasc. Surg. · Sep 2022
Comparison of homografts and bovine jugular vein conduits in the pulmonary position in patients <20 years of age.
To compare the performance of homografts and bovine jugular vein (BJV) conduits in the pulmonary position. ⋯ In patients age <20 years with a conduit >15 mm, PHs outperformed BJV conduits and AHs in the pulmonary position. The performance of AH and BJV was comparable. Small conduits (≤15 mm) had similar performance across all conduit types.
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The use of limited anatomic resection for early-stage lung cancer is widely practiced worldwide. However, most studies have focused on standard segmentectomy or subsegmentectomy, and data on the short-term outcomes after anatomic sublobar resection in China are lacking. ⋯ Despite the increasing proportion of complex cases treated with APL, the incidence of postoperative complications decreased as our center accumulated surgical experience. APL procedures are safe and feasible when conducted in a specialized center.