The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Normothermic ex vivo lung perfusion: Does the indication impact organ utilization and patient outcomes after transplantation?
Ex vivo lung perfusion (EVLP) is being increasingly applied as a method to evaluate and treat donor lungs for transplantation. However, with the previous limited worldwide experience, no studies have been able to evaluate the impact of indication for EVLP on organ utilization rates and recipient outcomes after lung transplantation (LTx). We examined these outcomes in a large-cohort, single-center series of clinical EVLP cases. ⋯ Clinical implementation of EVLP has allowed our program to expand the annual lung transplantation activity by 70% in this time period. It has improved confidence in the utilization of DCD lungs and BDD lungs, with an average 70% utilization of post-EVLP treated donor lungs with excellent outcomes, while addressing significant challenges in donor lung assessment and the logistics of "real-life" clinical lung transplantation.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
Higher clinical suspicion is needed for prompt diagnosis of esophageal adenocarcinoma in young patients.
Esophageal cancer is considered a disease of the elderly. Although the incidence of esophageal adenocarcinoma in young patients is increasing, current guidelines for endoscopic evaluation of gastroesophageal reflux disease and Barrett's esophagus include age as a cutoff. There is a paucity of data on the presentation and treatment of esophageal cancer in young patients. Most studies are limited by small sample sizes, and conflicting findings are reported regarding delayed diagnosis and survival compared with older patients. ⋯ In this study, young patients were more likely to have metastatic disease at diagnosis. Advanced stage in young patients may reflect the need for more aggressive clinical evaluation in high-risk young patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2020
A turbulence in vitro assessment of On-X and St Jude Medical prostheses.
The objective of this study was to investigate and compare the hemodynamic and turbulence characteristics upon implantation of St Jude Medical (SJM) (St Jude Medical, St Paul, Minn) and On-X (On-X Life Technologies, Kennesaw, Ga) bileaflet mechanical valves. Both valves are considered highly successful bileaflet mechanical valves characterized by good clinical outcomes despite their numerous design differences. Although thromboembolism remains the main disadvantage of bileaflet mechanical valves, On-X valves have been shown to need less anticoagulation therapy. ⋯ This study shows that despite the design differences that characterize the On-X valve, the hemodynamic and turbulence parameters were not necessarily improved compared with SJM.