Journal of Thoracic and Cardiovascular Surgery最新文献

Objective: This study described the structural and mechanical changes in the left atrium (LA) and left ventricle (LV) in a canine model of chronic mitral regurgitation (MR), in an attempt to identify markers linked to the onset of atrial tachyarrhythmias (ATA) or LV dysfunction.

Methods: Animals underwent baseline and terminal echocardiography and cardiac magnetic resonance imaging. Under echocardiographic guidance, chordae tendinae were avulsed until there was severe MR, defined by regurgitant jet area to LA area (RJA/LAA) of >70%. At terminal surgery, rapid atrial pacing was performed to test inducibility of ATA.

Result: Twelve canines underwent mitral valve chordae avulsion and were survived for an average of 8.8 ± 1.3 months. LA volume increased over 111% (p < 0.01), LV end systolic volumes increased over 57% (p < 0.01), and LV end diastolic volumes increased over 48% (p < 0.01). Increased LV mass was negatively correlated to ejection fraction (EF) (p = 0.01). During rapid atrial pacing, six canines developed inducible atrial arrhythmias. There were no differences in LA volume, function or LV strain between canines with ATAs and those without. Independently, six developed LV dysfunction with an average decrease of EF of 16 ± 4%. Canines with reduced EF experienced markedly increased LAV_min (p = 0.02) and impaired LV global radial strain (GRS) (p = 0.05).

Conclusion: Our experimental canine model replicated electrophysiological and hemodynamic consequences of clinical MR. Although LA function and LV strain did not associate with ATA inducibility, LAV_min , LV mass, and LV GRS emerged as potential indicators of LV dysfunction. These markers may have clinical value in guiding timely surgical intervention.

Objective: Renin-angiotensin aldosterone system (RAAS) signaling affects tumorigenesis and treatment susceptibility of various cancers. We investigate the impact of angiotensin-system inhibitors (ASI) on survival in patients treated with locally advanced esophageal adenocarcinoma (EAC).

Methods: EAC patients receiving trimodal therapy from 2002 to 2017 at a single institution were abstracted. Primary outcomes were overall survival (OS) and disease-free survival (DFS), analyzed with the Kaplan-Meier method, Cox regression, and propensity score-matched analysis. Secondary outcomes included pathologic complete response and tumor regression grade.

Results: 375 patients with EAC were included. 92 patients (25%) were ASI users (ASI⁺); 283 patients (75%) were ASI non-users (ASI^-). Median follow-up was 32.4 months. Compared to ASI^-, ASI⁺ were older (mean age 62 vs. 64) and had higher rates of comorbidities (P<.05 for all). Distribution of tumor stages was similar between groups (P=.3). Compared to ASI^-, ASI⁺ showed improved median OS (30 vs. 59 months, P=.025) and DFS (18 vs. 26 months, P=.032). After controlling for age and comorbidities, ASI⁺ showed improved OS (HR .633, P=.031) and DFS (HR .661, P=.036) compared to ASI^-. Among 182 propensity score-matched patients, ASI⁺ showed greater median OS (59 vs. 26 months, P=.025) and DFS (25 vs. 13 months, P=.030) than ASI^-. The HR was .623 for OS (95%CI .410-.946, P=.027) and .651 for DFS (95%CI .440-.961, P=.031), both favoring ASI⁺. No differences between groups were identified with respect to secondary outcomes (P>.05).

Conclusion: RAAS inhibition during esophageal cancer treatment is associated with improved outcomes. Our study suggests that ASIs may provide additional survival benefits in the multi-modality treatment of EAC.

Objective: Reported outcome in patients with bicuspid aortic valves(BAV) undergoing valve-sparing root replacement(VSRR) is scarce. This study aims to evaluate outcomes in patients with BAV, utilizing the reimplantation (David)technique.

Methods: Consecutive adult patients, with BAV, aortic root aneurysm and/or valve insufficiency(AI) undergoing VSRR(reimplantation)), were included, from 5 centers experienced in reimplantation-procedure. Patients were subcategorized into 2 groups with different primary indications for operation: 1) aneurysm, and 2) isolated AI.

Exclusion criteria: acute aortic dissection, endocarditis, and valvular-stenosis.

Results: 498 patients were included. Mean age 45.4(± 11.8); median follow-up was 5.4 years(IQR 2.3-8.7 years). Group 1: Aneurysm(N=144) and group 2: AI (N=354). There was one in-hospital death. Survival(overall) was 93.4% (95% CI 92-97%) at 10 years, no difference between groups(p=0.93). Freedom from reintervention at 1 year was 99.1% (95% CI 99-100%), at 5 years 95.4% (95% CI 93-97%), and at 10 years 89.2% (95% CI 86-93%); for patients with aneurysm 100% at 1 year and 95.4% (95% CI 92-98%) at 10 years; and for AI 98.9% (95% CI 98-99%) at 1 year and 86.4% (95% CI 83-91%) at 10 years. Cusp fenestrations(P=0.01), prolapse(P=0.04), and isolated AI(0.03) were associated with higher hazard of reintervention.

Conclusions: This multicenter study shows excellent results after VSRR, reimplantation procedure, in patients with BAV and aortic aneurysm and/or valve insufficiency. Isolated AI and cusp abnormalities are associated with higher reintervention rate and may reflect more advanced leaflet disease. The reimplantation technique, when performed in expert centers, appears to be an excellent treatment strategy in BAV.