Annals of Thoracic Surgery

Since the development of the first heart allocation system in 1988 to the most recent heart allocation system in 2018, the road to heart transplantation has continued to evolve. Policies were shaped with advances in temporary and durable left ventricular assist devices as well as prioritization of patients based on degree of illness. Herein, we review the changes in the heart allocation system over the past several decades and the impact of practice patterns across the United States.

BACKGROUND: Race is a potent influencer of healthcare access. Geography and income may exert equal or greater influence on patient outcomes. We sought to define the intersection of race, rurality, and income and their influence on access to minimally invasive lung surgery in Medicare beneficiaries. METHODS: Medicare and Medicaid Services data were used to evaluate patients with lung cancer who underwent right upper lobectomy, via open, robotic-assisted (RATS), or video-assisted thoracic surgery (VATS) between 2018 and 2020...

BACKGROUND: There are limited data comparing hemodynamic valve function in mechanical aortic valve prostheses. We compared the hemodynamic function of two commonly used mechanical aortic valve (AV) prostheses, the On-X and Top Hat valves. METHODS: Retrospective analysis of 512 patients who received AV replacement with On-X (n=252, 49%) or Top Hat (n=260, 51%) mechanical valves between 2011 and 2019. Patients were matched based on select variables. Echocardiographic data were collected pre- and postoperatively over a median follow-up of 1...

BACKGROUND: Debate continues regarding the superiority of porcine versus pericardial bioprostheses, and data relevant to this comparison are scant. We therefore compare late survival and structural valve deterioration of porcine and pericardial mitral valve prostheses. METHODS: Adults undergoing mitral valve replacement with one first-generation porcine valve model and one pericardial valve line were reviewed from our prospectively-maintained institutional database between 1976 and 2020...

We repaired a left anomalous aortic origin of coronary artery (AAOCA) using coronary ostium translocation/re-implantation. Re-repair was required due to suboptimal flow pattern in postoperative transesophageal echocardiography (TEE), confirmed with coronary angiography. We emphasize the importance of early recognition, diagnosis and intervention to deal with a problem with the coronary repair.

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Neoadjuvant immunotherapy has gone from an idea to an indication in locally advanced lung cancer. Several phase III trials have demonstrated the superiority of neoadjuvant chemoimmunotherapy compared to chemotherapy in this setting. Although such progress has revolutionized the treatment of locally advanced disease, the unmet needs of stage I and stage II patients without lymph node disease have largely been under-represented in existing trials. Up-front surgery with few patients going on to complete adjuvant therapy remains the norm for most stage I-II patients...

In 1945, the Welsh surgeon Ivor Lewis first reported performing the resection of a mid-esophageal tumor through a combined approach involving the abdomen and right chest. While his technique was initially rebuffed by the preeminent esophageal surgeons of the time, it quickly became the standard approach for cancers of the mid-esophagus. Here we review the development and early dissemination of Lewis' operation using the case of the American actor Humphrey Bogart who underwent an Ivor Lewis esophagectomy for esophageal cancer in 1956...

BACKGROUND: Females with mitral valve disease have higher rates of tricuspid regurgitation(TR) than males. While tricuspid valve repair(TVr) decreases progression of TR, we hypothesize that there may be sex-based differences in concomitant TVr at the time of mitral surgery. METHODS: Adults undergoing mitral surgery for degenerative disease with moderate or worse preoperative TR at a high-volume center from 2014-2023 were identified. Patients with previous tricuspid intervention were excluded...

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