The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Expanding the indication for sutureless aortic valve replacement to patients with mitral disease.
To review our experience with sutureless aortic valve replacement (AVR) in the setting of concomitant mitral valve (MV) surgery and discuss the technical considerations. ⋯ In our experience, sutureless AVR in the setting of concomitant mitral surgery is a feasible and reproducible procedure. Elderly patients undergoing multiple valve surgery present a higher operative risk, therefore extending the indication for sutureless AVR to patients with concomitant mitral disease could greatly benefit this specific population.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Prognostic significance of histologic differentiation, carcinoembryonic antigen value, and lymphovascular invasion in stage I non-small cell lung cancer.
For stage I non-small cell lung cancer (NSCLC), the only 2 prognostic factors incorporated into the seventh edition of the TNM staging system were tumor size and visceral pleural invasion. However, with this staging system, the prognostic precision of survival has proved elusive, suggesting the need to include additional prognostic factors. To improve prognostic applications and treatment decisions, we investigated clinicopathologic factors affecting progression-free survival in patients with surgically resected stage I NSCLC. ⋯ In addition to tumor size, we identified 3 other independent risk factors for recurrence in patients with stage I NSCLC. These 3 risk factors warrant consideration as additional predictors in the next version of the TNM staging system.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Early left ventricular regional contractile impairment in chronic mitral regurgitation occurs in a consistent, heterogeneous pattern.
The clinical guidelines for asymptomatic patients with chronic mitral regurgitation (MR) use the ejection fraction (EF) to trigger surgical referral. We hypothesized that the EF is not sensitive enough to detect the earliest contractile injury in chronic MR and that the injury associated with chronic MR is not global but heterogeneous, occurring regionally and predictably, before the onset of global left ventricular (LV) dysfunction. ⋯ The earliest contractile injury seen in patients with MR is heterogeneous and consistently distributed along the LV septum. Compensatory responses include hypercontractility of other regions. These data suggest that rather than relying on global LV contractile metrics, which cannot detect early injury, patients might be better served by undergoing directed surveillance of "sentinel" LV regions (LV septum) with high-resolution metrics of regional contractile function.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
22q11.2 Deletion syndrome is associated with increased perioperative events and more complicated postoperative course in infants undergoing infant operative correction of truncus arteriosus communis or interrupted aortic arch.
The effect of genotype on the outcomes of infant cardiac operations has not been well established. The purpose of the present study was to investigate the effect of 22q11.2 deletion (22q11del) on infants with truncus arteriosus communis (TA) and interrupted aortic arch (IAA) undergoing operative correction during infancy. ⋯ In this study, 22q11del is associated with perioperative outcomes in infants undergoing operative correction of TA and IAA, with longer hospital stays and greater resource utilization in the perioperative period. These findings should inform counseling and risk stratification and warrant additional study to identify genotype-specific management strategies to improve outcomes.
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J. Thorac. Cardiovasc. Surg. · Oct 2014
Supraclavicular node metastasis from thoracic esophageal carcinoma: A surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer.
In the present TNM classification, involvement of supraclavicular nodes is defined as distant metastases. However, the therapeutic value of supraclavicular node dissection remains controversial. The purpose of this study was to evaluate the survival benefit of dissection of metastases to the supraclavicular lymph nodes in patients with thoracic esophageal carcinoma by using a large nationwide registry of esophageal cancer maintained by the Japanese Esophageal Society. ⋯ The survival benefit of dissection of metastases to the supraclavicular lymph nodes was indicated in patients with thoracic esophageal carcinoma. Supraclavicular nodes appear to be regional nodes similar to other regional nodes.