The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2019
Multicenter Study Comparative StudyFeatures associated with myocardial ischemia in anomalous aortic origin of a coronary artery: A Congenital Heart Surgeons' Society study.
We sought to determine anatomic features associated with evidence of myocardial ischemia and sudden cardiac events (arrest or death) for patients with anomalous aortic origin of a coronary artery. ⋯ Anatomic features including coronary artery involved, intramural course and length, and orifice anomalies were associated with evidence of myocardial ischemia for patients with anomalous aortic origin of a coronary artery. These features might importantly inform risk stratification and decisions regarding surgical management.
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J. Thorac. Cardiovasc. Surg. · Sep 2019
Comparative StudyReadmission rates following esophageal cancer resection are similar at regionalized and non-regionalized centers: A population-based cohort study.
Readmission following esophagectomy affects the patient experience, has important economic implications, and can be tied to hospital reimbursement. Ontario has regionalized thoracic centers; regionalized surgery may lower the readmission rate. We investigated whether surgery at regionalized thoracic centers is associated with reduced readmission following esophageal cancer resection. ⋯ Surgery at a designated thoracic surgery center did not reduce the risk of 90-day readmission following esophageal cancer resection, and readmission rates varied significantly even across thoracic centers. Our results suggest that despite universal, regionalized esophageal cancer care, there appears to be a minimum readmission threshold following esophagectomy that may be clinically necessary.
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J. Thorac. Cardiovasc. Surg. · Sep 2019
Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience.
To assess outcomes of endovascular reperfusion followed by delayed open aortic repair for stable patients with acute type A aortic dissection and mesenteric malperfusion syndrome (mesMPS). ⋯ In patients with acute type A aortic dissection with mesMPS, endovascular fenestration/stenting, and delayed open aortic repair achieved favorable short- and long-term outcomes. Surgeons should consider correcting mesenteric malperfusion before undertaking open aortic repair in patients with mesMPS, especially those with acute stroke, gross bowel necrosis at laparotomy, or serum lactate ≥6 mmol/L.
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J. Thorac. Cardiovasc. Surg. · Sep 2019
Sutureless repair for postinfarction left ventricular free wall rupture.
Left ventricular free wall rupture is a catastrophic complication of acute myocardial infarction. Sutureless repair has been reported to be an effective surgical procedure for left ventricular free wall rupture. However, the outcomes of sutureless repair remain unclear. ⋯ Sutureless repair using TachoComb/TachoSil patches can be a viable treatment option for left ventricular free wall rupture. Care should be taken when applying this technique in cases of the blow-out type left ventricular free wall rupture.
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J. Thorac. Cardiovasc. Surg. · Sep 2019
Time-to-operation does not predict outcome in acute type A aortic dissection complicated by neurologic injury at presentation.
Neurologic injury complicating the presentation of acute type A aortic dissection remains a challenge for cardiac surgeons. ⋯ Neurologic injury at the time of presentation with acute type A aortic dissection was associated with an increased risk of in-hospital mortality. Among patients with persistent neurological deficits, time-to-operation failed to predict either neurologic outcome or perioperative mortality suggesting that longer time from onset of symptoms of neurologic injury should not act as a contraindication to proceeding to the operating room for expedient repair.