The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2017
CommentMechanical valves in the pulmonary position: An international retrospective analysis.
Life expectancy of patients with congenital heart disease has improved over the past decades, increasing the need for a durable pulmonary prosthetic valve. Biological valves in various forms have become the valve of choice for pulmonary valve replacement (PVR), but structural valve deterioration is unavoidable in the long term. Use of a mechanical valve could be an alternative, but data on long-term outcomes are sparse. ⋯ Mechanical PVR is associated with a limited risk of valvular thrombosis. Thrombolysis was an effective treatment in the majority.
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J. Thorac. Cardiovasc. Surg. · Oct 2017
Improving coronary artery bypass grafting readmission outcomes from 2000 to 2012 in the Medicare population.
The study objective was to examine trends in 30-day readmission after coronary artery bypass grafting in the Medicare population over 13 years. ⋯ In a large cohort of Medicare patients undergoing coronary artery bypass grafting over 13 years, there was a significant decrease in 30-day readmission rates, a reduction in readmission for wound infections, and reduced mortality during the readmission episode, despite an increase in patient comorbidities. The improvement in readmission rates was seen regardless of patient variables examined.
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J. Thorac. Cardiovasc. Surg. · Oct 2017
Prognostic impact of stathmin 1 expression in patients with lung adenocarcinoma.
Stathmin 1 is a major cytosolic phosphoprotein that regulates microtubule dynamics and is associated with malignant phenotypes in various cancers, including non-small cell lung cancer. We aimed to determine differences in overall survival and disease-free proportion in patients with lung adenocarcinoma stratified by stathmin 1 tumor expression. ⋯ Stathmin 1 expression was an independent prognostic factor for adenocarcinoma, even when restricted to patients with early-stage cancer.
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J. Thorac. Cardiovasc. Surg. · Oct 2017
Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: A single-institute retrospective review.
Anatomic resection of the dorsal area of the basal segment of the lower lobe is difficult because of the deep location of vessels and bronchi in the parenchyma. This study aimed to describe a novel technique for port-access thoracoscopic segmentectomy of the dorsal (S10) and lateral dorsal segments (S9+10). ⋯ The posterior approach for port-access thoracoscopic segmentectomy at S10 or S9+10 is technically challenging, but in our hands it has been feasible. It exposes the targeted bronchus (B10, B9+10) and artery (A10, A9+10) and enables anatomic S10 and S9+10 segmentectomy while avoiding inessential parenchymal splitting from the major fissure.
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J. Thorac. Cardiovasc. Surg. · Oct 2017
Early Trifecta valve failure: Report of a cluster of cases from a tertiary care referral center.
The Trifecta valve (St Jude Medical, Inc, St Paul, Minn) was approved for commercial use by the US Food and Drug Administration in 2011. Several isolated cases have been reported since then, describing early structural valve deterioration. We report a case series of 8 Trifecta valve failures, describing patients' clinical substrate and management, and the pathologic characteristics of the explanted valves. ⋯ Our findings provide further insights into the pathologic mechanisms leading to early Trifecta valve failure. In addition to tear of the noncoronary cusp of the Trifecta prosthesis described as the most common mechanism in the literature for its failure, circumferential pannus formation composed of fibrofatty tissue in the inflow portion and leaflet calcification concentrated around the posts in the outflow portion are important mechanisms contributing toward early Trifecta valve failure.