The Annals of thoracic surgery
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Comparative Study
Enlargement of the small aortic root during aortic valve replacement: is there a benefit?
Aortic root enlargement (ARE) at the time of aortic valve replacement (AVR) is an often proposed but still unproven technique to prevent prosthesis-patient mismatch. To evaluate the risks and benefits of ARE, we examined the outcomes of patients with small aortic roots who underwent AVR with or without the use of ARE. ⋯ For patients with small aortic roots, ARE at the time of AVR is a safe procedure that reduces postoperative gradients and the incidence of prosthesis-patient mismatch. However, ARE does not appreciably improve long-term clinical outcomes.
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Accurate staging of lung cancer requires noninvasive and pathologic examination of intrathoracic lymphadenopathy, which determines both the treatment options and prognosis. The gold standard for mediastinal staging has been mediastinoscopy. Other options include video-assisted thoracoscopic surgery, blind transbronchial needle aspiration, and endoscopic ultrasound-guided fine-needle aspiration. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has recently been introduced. Here we report the use of EBUS-TBNA as a diagnostic modality for mediastinal adenopathy and staging modality for lung cancer. ⋯ EBUS-TBNA is useful in accessing mediastinal and hilar lymph nodes for the diagnosis and staging of non-small cell lung cancer and other disorders of the mediastinum. Thoracic surgeons and pulmonologists are well positioned to use this tool in everyday practice.