The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2015
Preoperative (3-dimensional) computed tomography lung reconstruction before anatomic segmentectomy or lobectomy for stage I non-small cell lung cancer.
Accurate cancer localization and negative resection margins are necessary for successful segmentectomy. In this study, we evaluate a newly developed software package that permits automated segmentation of the pulmonary parenchyma, allowing 3-dimensional assessment of tumor size, location, and estimates of surgical margins. ⋯ This preoperative 3-dimensional computed tomography analysis of segmental anatomy can confirm the tumor location within an anatomic segment and aid in predicting surgical margins. This 3-dimensional computed tomography information may assist in the preoperative assessment regarding the suitability of segmentectomy for peripheral lung cancers.
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J. Thorac. Cardiovasc. Surg. · Sep 2015
The effect of surgeon volume on procedure selection in non-small cell lung cancer surgeries.
Procedure selection by the surgeon can greatly affect patients' operative and long-term survival. This selection potentially reflects comfort with technically challenging surgeries. This study aims to examine surgeon choices for non-small cell lung cancer and whether surgeon volume predicts the type of procedure chosen, controlling for patient demographics, comorbidity, year of surgery, and institutional factors. ⋯ Although patient and temporal factors influence the type of resection a patient receives for non-small cell lung cancer, surgeon volume also is a strong predictor. This study may be limited by minimal stage data, but the suggestion that a surgeon's total procedural volume for non-small cell lung cancer significantly influences procedure selection has implications on how we deliver care to this patient population.
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J. Thorac. Cardiovasc. Surg. · Sep 2015
Anatomic variability of the thoracic duct in pediatric patients with complex congenital heart disease.
Thoracic duct mass ligation (TDML) through a right thoracotomy (RT), regardless of the side of the pleural effusion, is a standard procedure for chylothorax that is refractory to medical treatment. This procedure may be unsuccessful in patients with complex congenital heart disease, which necessitates additional left thoracotomy (LT) for left periaortic mass ligation. We hypothesized that failure of the right-sided approach is attributable to the anatomic variation of the path of the thoracic duct. ⋯ The path of the thoracic duct may vary in pediatric patients with complex congenital heart disease. Left periaortic mass ligation should be considered in patients with chylothoraces that persist after the right-sided approach, especially in patients with dextrocardia.
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J. Thorac. Cardiovasc. Surg. · Sep 2015
Comparative StudyInfluence of aortitis on late outcomes after repair of ascending aortic aneurysms.
To determine outcomes of repair of ascending aortic aneurysms in patients with histopathologic diagnoses of aortitis. ⋯ Patients with repaired ascending aneurysms secondary to noninfectious aortitis have low early mortality, but late risks of death and aortic reoperation are increased, compared with these outcomes for patients with aneurysms that result from medial degeneration.
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J. Thorac. Cardiovasc. Surg. · Sep 2015
Comparative StudyArterial coronary artery bypass grafting is safe and effective in elderly patients.
Bilateral internal thoracic artery grafting in elderly patients is controversial. We compared the outcome of bilateral internal thoracic artery grafting with that of single internal thoracic artery and saphenous vein and radial artery conduits in these patients. ⋯ This study supports the use of arterial grafts in elderly patients undergoing coronary artery bypass grafting.