The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Personalizing Patient Risk of a Life Altering Event: An Application of Machine Learning to Hemiarch Surgery.
To assess a machine learning model's ability to predict the occurrence of life altering events (LAE) in hemiarch surgery and determine contributing patient characteristics and intraoperative factors. ⋯ Machine learning demonstrated superior accuracy in predicting hemiarch patients that would experience a LAE. This model may help to guide patients and clinicians in stratifying risk on an individual basis, which may in turn influence clinical decision-making.
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Segmentectomy is becoming the standard of care for small, peripheral non-small cell lung cancer. To improve perioperative management in this population, this study aims to identify factors influencing hospital length of stay after segmentectomy. ⋯ Older patients, those with reduced pulmonary function, current, and past smokers have elevated risk for prolonged hospital stays after segmentectomy. Validation of our nomogram could improve perioperative risk stratification in segmentectomy patients.
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J. Thorac. Cardiovasc. Surg. · Apr 2024
The impact of permanent pacemaker implantation on long-term survival following cardiac surgery; A systematic review and meta-analysis.
The long-term impact of permanent pacemaker (PPM) implantation on survival following cardiac surgery remains ill defined. We aimed to investigate the impact of PPM on survival and explore factors driving outcomes using meta-regression according to the type of surgery. ⋯ PPM implantation following cardiac surgery is associated with a higher risk of long-term all-cause mortality and heart failure rehospitalization. This impact is more prominent in patients undergoing aortic valve surgery or atrioventricular block as an indication than those undergoing mitral or tricuspid valve surgery.
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J. Thorac. Cardiovasc. Surg. · Apr 2024
Locally Advanced Esophageal Cancer Patients With Complete Clinical Response Post Neoadjuvant Chemoradiotherapy: A Markov Decision Analysis of Esophagectomy versus Active Surveillance.
Chemoradiation followed by esophagectomy is a standard treatment option for locally advanced esophageal cancer (LAEC) patients. Esophagectomy is a high-risk procedure, and recent evidence suggests select patients may benefit from omitting or delaying surgery. This study aims to compare surgery versus active surveillance for LAEC patients with complete clinical response (cCR) after neoadjuvant chemoradiotherapy (nCRT). ⋯ Our study finds that surgery increases life expectancy but decreases quality-adjusted life years. Although the incremental change in QALY for either modality is insufficient to make broad clinical recommendations, our study demonstrates that either approach is acceptable. As probabilities of key factors are further defined in the literature, treatment decisions for patients with LAEC and a cCR after nCRT should consider histology, patient values, and quality of life.