The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Multicenter StudyMachine Learning and Decision Making in Aortic Arch Repair.
Decision making during aortic arch surgery regarding cannulation strategy and nadir temperature are important in reducing risk, and there is a need to determine the best individualized strategy in a data-driven fashion. Using machine learning (ML), we modeled the risk of death or stroke in elective aortic arch surgery based on patient characteristics and intraoperative decisions. ⋯ Using ML, we can more accurately identify patients at risk of death and stroke, as well as the strategy that better reduces the risk of adverse events compared to traditional prediction models. Operative decisions made may be tailored based on a patient's specific characteristics, allowing for maximized, personalized benefit.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Comparative StudyComparing 3-Year Survival and Readmissions between HeartMate 3 and Heart Transplant as Primary Treatment for Advanced Heart Failure.
To compare 3-year survival and readmissions of patients who received the HeartMate 3 (HM3) left ventricular assist device (LVAD) or underwent orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure. ⋯ This exploratory analysis suggests that for similar patients, HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure but may result in more readmissions.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Preoperatively Predicting Survival Outcome for Clinical Stage IA Pure-Solid Non-Small Cell Lung Cancer by Radiomics-based Machine Learning.
Clinical stage IA non-small cell lung cancer (NSCLC) showing a pure-solid appearance on computed tomography is associated with a worse prognosis. This study aimed to develop and validate machine-learning models using preoperative clinical and radiomic features to predict overall survival (OS) in clinical stage IA pure-solid NSCLC. ⋯ A radiomics-based machine-learning model can preoperatively and accurately predict OS and improve survival stratification in clinical stage IA pure-solid NSCLC.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Natural History of the Distal Aorta Following Elective Root Replacement in Patients with Marfan Syndrome.
It is unclear if the addition of a prophylactic arch operation is beneficial at the time of root replacement in patients with Marfan syndrome (MFS). This project aims to understand the fate of the distal aorta following elective root replacement in patients with MFS. ⋯ The distal aorta (including the clamp and cannulation site) overall appears stable in patients with MFS following elective root replacement without prophylactic arch operation. Development of TBAD seems to be the primary driver of distal degeneration. Factors associated with TBAD development included hypertension, underscoring the importance of strict blood pressure control in these patients.
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J. Thorac. Cardiovasc. Surg. · Jan 2025
Valve Sparing Aortic Root Replacement: long-term variables significantly associated with mortality and morbidity.
In aortic root surgery, valve-sparing aortic root replacement is an attractive alternative by mitigating the risks inherent to prosthetic valves; however, little is known about the variables that impact its durability. We review our mid- to long-term outcomes after valve-sparing aortic root replacement and describe factors that impact survival and valve reintervention and insufficiency. ⋯ Valve-sparing aortic root replacement has excellent long-term outcomes, with low mortality and reintervention rates. Concomitant leaflet repair and bicuspid valve disease are the only long-term factors associated with reintervention.