The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 2012
Trends in isolated coronary artery bypass grafting: an analysis of the Society of Thoracic Surgeons adult cardiac surgery database.
Coronary artery bypass grafting (CABG) is the operation most commonly performed by cardiac surgeons. There are few contemporary data examining evolving patient characteristics and surgical outcomes of isolated CABG. We used the Society of Thoracic Surgeons adult cardiac surgery database to characterize trends in patient characteristics and outcomes after CABG over the past decade. ⋯ Over the past decade, the risk profile of patients undergoing CABG has changed, with fewer smokers, more diabetic patients, and better medical therapy characterizing patients referred for surgical coronary revascularization. The left internal thoracic artery is nearly universally used and outcomes have improved substantially, with a significant decline in postoperative mortality and morbidity.
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J. Thorac. Cardiovasc. Surg. · Feb 2012
Multicenter StudyRobotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results.
We evaluated a large series of patients undergoing robotic lobectomy for the treatment of early-stage non-small cell lung cancer (NSCLC) to assess long-term oncologic efficacy. ⋯ Robotic lobectomy for early-stage NSCLC can be performed with low morbidity and mortality. Long-term stage-specific survival is acceptable and consistent with prior results for VATS and thoracotomy.
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J. Thorac. Cardiovasc. Surg. · Feb 2012
Editorial Biography Historical ArticleHistorical perspectives of The American Association for Thoracic Surgery: Alfred Blalock (1899-1964).
Great men are not a common occurrence. Indeed, they are a rare find. Though respected and lauded in their time, it is only in retrospect that their true contributions can be adequately measured as a surgeon, an educator and a scientist. ⋯ His continual reach for excellence helped him to not only affect, but revolutionize the paradigm of surgical research, an understanding of the physiology of shock and the surgical management of pulmonic stenosis/atresia. Dr. Blalock was the 30th president of the American Association for Thoracic Surgery and his presidential address was given in 1951.
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J. Thorac. Cardiovasc. Surg. · Feb 2012
Comparative StudyEffect of aneurysm on the mechanical dissection properties of the human ascending thoracic aorta.
The acute dissection of an ascending thoracic aortic aneurysm (ATAA) represents a devastating separation of elastic layers occurring when the hemodynamic loads on the diseased wall exceed the adhesive strength between layers. At present, the mechanics underlying aortic dissection are largely unclear, and the biomechanical delamination properties of the aneurysmal aorta are not defined. Individuals with bicuspid aortic valve (BAV) are particularly predisposed to ascending aortic aneurysm formation, with a marked risk of aortic dissection. The purpose of this study was to evaluate and compare the dissection properties of nonaneurysmal and aneurysmal human ascending thoracic aorta from patients with BAV morphology or normal tricuspid aortic valve (TAV) morphology using biomechanical delamination testing. ⋯ The tensile testing results suggest that the weaker intimal half of the aortic wall might fail before the outer adventitial half. Scanning electron microscope analyses suggest different failure modalities of dissection between the two morphologies, and the lower S(d) in ATAAs appears to be associated with a disorganized microstructure. BAV ATAAs have a lower S(d) than TAV ATAAs, suggesting a greater propensity for aortic dissection.
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J. Thorac. Cardiovasc. Surg. · Feb 2012
The impact of additional epicardial imaging to transesophageal echocardiography on intraoperative detection of residual lesions in congenital heart surgery.
Transesophageal echocardiography is the primary intraoperative imaging modality used to evaluate cardiac surgery. Its predecessor, epicardial echocardiography, enables visualization of certain cardiovascular structures that are beyond the visual scope of transesophageal echocardiography. We review the current use of epicardial echocardiography to analyze its contemporary application and benefit. ⋯ Epicardial echocardiography detects residual intraoperative lesions not visualized by transesophageal echocardiography, most frequently related to pulmonary arteries. Its use, in addition to standard transesophageal echocardiography, may decrease the need for early reintervention.