The Annals of thoracic surgery
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Presently, there are wide variations in cardiac anatomies requiring single ventricular palliation and these variations may have an impact on the incidence of atrioventricular valve regurgitation. ⋯ If performed properly, atrioventricular valve repair may neutralize the risk of regurgitation regardless of the valve morphology. The effort to incorporate the mitral valve into the systemic circulation may be important to reduce tricuspid regurgitation. The effort to decompress a nonsystemic left ventricle, if present, may be important to avoid unfavorable ventricular interactions on the mitral valve.
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Multicenter Study
Transapical aortic valve implantation in high-risk patients with severe aortic valve stenosis.
Transapical aortic valve implantation (TA-TAVI) represents an alternative in patients with symptomatic severe aortic valve stenosis (SSAVS) who cannot be operated on or have a high surgical risk. The aim of this prospective multicenter observational study was to assess early and 2-year clinical and hemodynamic outcomes after TA-TAVI. ⋯ TA-TAVI provides excellent early and 2-year results in terms of survival, valve-related adverse events, and hemodynamic performance. Survival after TA-TAVI is affected by the center learning curve and by the occurrence of an intraoperative complication.
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Survival after blunt neck trauma resulting in combined tracheal and esophageal injury is uncommon. We present the case of a young boy who sustained complete transection of the trachea and subtotal transection of the esophagus after a clothes line type injury.
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Comparative Study
Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers.
We evaluated a cohort of patients who underwent resection for small (2 cm or less) non-small cell lung cancer (NSCLC) to determine if there is an association between extent of resection (lobar versus sublobar resection) and local recurrence or survival. ⋯ Sublobar resection is reasonable in older patients with limited cardiopulmonary function. For healthy patients, however, lobectomy remains the standard therapy, with sublobar resection with lymph node sampling representing an alternative to consider. These findings support continued effort to conduct a randomized trial of lobar versus sublobar resection, such as CALGB 140503.
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The existing guidelines for extent of resection of carcinoid tumors are based on other, more malignant non-small cell lung cancers. Because of the small number of patients in any single institution, we analyzed the Surveillance Epidemiology and End Results (SEER) database to study the effect of the extent of resection of these tumors on overall survival. ⋯ Sublobar resection of carcinoid tumors did not compromise oncologic outcomes in a large population-based database. Lobectomy for typical carcinoid tumors is not mandatory as long as complete resection and adequate mediastinal staging are performed.