The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter Study Observational StudyCompleteness of coronary revascularization and survival: Impact of age and off-pump surgery.
We conducted a multicenter observational cohort study of the effect of completeness of revascularization on long-term survival after coronary artery bypass grafting. We also investigated the impact of age and off-pump surgery. ⋯ Incomplete revascularization is associated with decreased long-term survival, even in elderly patients. Surgeons should consider these findings when choosing a revascularization strategy, particularly if off-pump coronary artery bypass grafting is contemplated.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
High basal level of autophagy in high-altitude residents attenuates myocardial ischemia-reperfusion injury.
Hypoxia can induce autophagy, which plays an important role in cardioprotection. The present study tested the hypothesis that patients with congenital heart disease living at a high altitude could resist ischemia-reperfusion injury better than those at a low altitude, through elevated basal autophagy by chronic hypoxia. ⋯ Patients living at a high altitude with congenital heart disease resisted ischemia-reperfusion injury during cardiac surgery better than those at a low altitude, possibly through elevated basal autophagy induced by chronic hypoxia.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Comparative StudyClinical outcomes and changes in lung function after segmentectomy versus lobectomy for lung cancer cases.
We compared the clinical outcomes and changes in pulmonary function test (PFT) results after segmentectomy or lobectomy for non-small cell lung cancer. ⋯ Both surgical types were safe. We would advocate lobectomy for patients with stage IA disease, especially those with T1b. A retrospective study with a large sample size and more detailed information should be conducted for PFT evaluation, with additional stratification by lobe and laterality.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Multicenter StudyTotal arterial revascularization with internal thoracic and radial artery grafts in triple-vessel coronary artery disease is associated with improved survival.
We sought to evaluate our experience with total arterial revascularization and compare it with the traditional approach of a single internal thoracic artery supplemented by saphenous veins. ⋯ This large multicenter study suggests that a strategy of total arterial revascularization is associated with improved long-term survival compared with the use of only a single arterial and saphenous vein grafts. Total arterial revascularization should be encouraged in patients with a reasonable life expectancy.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Comparative StudyMitral valve annuloplasty and anterior leaflet augmentation for functional ischemic mitral regurgitation: quantitative comparison of coaptation and subvalvular tethering.
Although restrictive mitral annuloplasty (RMA) has been the preferred surgical treatment of functional ischemic mitral regurgitation (FIMR), some patients with severely dilated left ventricles will experience recurrent mitral regurgitation (MR). Consequently, new surgical strategies have been entertained to compensate for severely dilated ventricles by maximizing coaptation and reducing subvalvular tethering. Anterior leaflet augmentation (ALA) with mitral annuloplasty has been theorized to meet these goals. We compared the mechanistic effects of RMA and adjunct ALA in the setting of FIMR. ⋯ A large ALA procedure created the greatest coaptation and reduced chordal tethering. Although all repairs abolished MR acutely, the repairs that create the greatest coaptation might conceivably produce a more robust and lasting repair in the chronic stage. A clinical need still exists to best identify which patients with altered mitral valve geometries would most benefit from an adjunct procedure or RMA alone.