Journal of Thoracic and Cardiovascular Surgery (J THORAC CARDIOV SUR )

Publisher: American Association for Thoracic Surgery; Western Thoracic Surgical Association, Elsevier


The Journal presents original, exclusive articles on conditions of the chest, heart, lungs, and great vessels where surgical intervention is indicated. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the journal focuses on techniques and developments in cardiac surgery, pacemaker insertion/removal, lung and esophageal surgeries, heart and lung transplantation, and other procedures. The Journal of Thoracic and Cardiovascular Surgery ranks in the top 3.3% of the 4,779 scientific journals most frequently cited (Science Citation Index). It is also recommended for initial purchase in the Brandon-Hill study, Selected List of Books and Journals for the Small Medical Library (1997/98 Edition).

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  • Website
    The Journal of Thoracic and Cardiovascular Surgery website
  • Other titles
    Journal of thoracic and cardiovascular surgery
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  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publisher details


  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
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    • Pre-print allowed on any website or open access repository
    • Voluntary deposit by author of authors post-print allowed on authors' personal website, or institutions open scholarly website including Institutional Repository, without embargo, where there is not a policy or mandate
    • Deposit due to Funding Body, Institutional and Governmental policy or mandate only allowed where separate agreement between repository and the publisher exists.
    • Permitted deposit due to Funding Body, Institutional and Governmental policy or mandate, may be required to comply with embargo periods of 12 months to 48 months .
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    • Must link to journal home page or articles' DOI
    • Publisher's version/PDF cannot be used
    • Articles in some journals can be made Open Access on payment of additional charge
    • NIH Authors articles will be submitted to PubMed Central after 12 months
    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the present study was to evaluate the early clinical outcomes of aortic root surgery in the United States.
    Journal of Thoracic and Cardiovascular Surgery 01/2015; 149(1):116-122.
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    ABSTRACT: Objective To evaluate 30-day and 90-day mortality after major pulmonary resection for lung cancer including the relationship to hospital volume. Methods Major lung resections from 2007-2011 were identified in the National Cancer Data Base. Mortality was compared according to annual volume, demographic and clinical covariates using univariate and multivariable analyses, and included comorbidity information. Statistical significance (p<0.05) and 95% confidence intervals were assessed. Results There were 124,418 major pulmonary resections identified in 1,233 facilities. The 30-day mortality rate was 2.8%. The 90-day mortality rate was 5.4%. Hospital volume was significantly associated with 30-day mortality, with a mortality of 3.7% for volumes <10, and 1.7% for volumes of 90 or more. Other variables significantly associated with 30-day mortality include older age, male sex, higher stage, pneumonectomy, a prior primary cancer, and multiple comorbidities. For 90-day mortality rates similar results were found. In the multivariate analysis hospital volume remained significant, with adjusted odds ratios of 2.1 (CI: 1.7-2.6) for 30-day mortality and 1.3 (CI: 1.1-1.6) for conditional 90-day mortality for the lowest (<10) volume compared to the highest (>90) volume hospitals. Hospitals with volume < 30 had an adjusted odds ratio for 30 day mortality of 1.3 (CI 1.2-1.5) compared to those with a volume >30. Conclusion Mortality at 30 and 90 days and hospital volume should be monitored by institutions performing major pulmonary resection and benchmarked against hospitals performing at least 30 resections per year.
    Journal of Thoracic and Cardiovascular Surgery 11/2014;
  • Journal of Thoracic and Cardiovascular Surgery 11/2014;
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    ABSTRACT: Background This study describes echocardiographic allograft valve function over time in a cohort of patients who were prospectively followed after allograft aortic valve or root replacement, illustrating the use of longitudinal data analysis for assessing valve function over time. Methods and Results Serial, standardized echocardiographic measurements of aortic regurgitation (AR), aortic gradient, annulus diameter, left ventricular outflow tract (LVOT) diameter and aortic diameter in 301 hospital survivors (mean age 46 years; range 16-83) after allograft aortic valve (N=77) or root replacement (N=224) were analyzed using non-linear longitudinal models. AR increased over time. At 15 years 41% of patients had at least moderate AR. Younger patient age and subcoronary implantation technique were associated with increased AR. Aortic gradient increased over time (from 9.4 mmHg at 6 months to 21.3 mmHg at 15 years); both initial and increase in aortic gradient were greater in younger patients and after subcoronary implantation technique. Annulus diameter slightly increased (from 21.9 mm at 6 months to 22.4 mm at 15 years) while aortic diameter slightly decreased over time (from 34.3 mm at 6 months to 32.7 mm at 15 years). LVOT diameter remained constant at 22 mm. Younger patients in the subcoronary implantation group had a larger annulus diameter. Conclusions Both aortic regurgitation and stenosis increase over time after allograft aortic valve or root replacement. Younger patient age and use of the subcoronary implantation technique are associated with increased regurgitation and stenosis. The use of non-linear longitudinal models allows for an insightful analysis of allograft valve function over time.
    Journal of Thoracic and Cardiovascular Surgery 11/2014;
  • Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1273-4.
  • Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1149-51.
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    ABSTRACT: Objective In order to prevent postoperative migrations and endoleaks after endovascular aneurysm repair (EVAR), we developed a tissue-engineered vascular graft that integrates with the aortic wall by recruiting the host tissue into the graft scaffold. In this study, we assessed the mechanical properties of the new graft, and evaluated the integration between the graft and the aortic wall histologically and mechanically in canine models. Methods The tissue-engineered vascular graft was woven to be partially degradable with a double-layered fiber (core; polyethylene terephthalate (PET), sheath; polyglycolic acid (PGA)) (PET/PGA graft). The mechanical properties of the graft were assessed in comparison with a thin-walled woven polyester graft (control graft). The stent-grafts, composed of a stainless Z stent (20mm in diameter, 25mm in length) and a PET/ PGA or a control graft (12 mm in diameter, 30 mm in length), (n=5 in each group), were implanted in the descending thoracic aorta of mongrel dogs for 2 months. We assessed the histology of the explants and the degree of adhesion between the graft and the aortic wall. Results The PET/PGA achieved nearly the same mechanical properties as those of the control graft in tensile strength and flexibility, but slightly higher water permeability. At 2 months after implantation, in the PET/PGA group, the PGA component degraded and was replaced by host tissue that contained a mixture of α-smooth muscle actin positive cells and other host cells, and the graft was observed as a unified structure with the aorta. The adhesion strength between the graft and the aortic wall was significantly enhanced in the PET/PGA group. Conclusion The PET/PGA stent-graft demonstrated a histological and mechanical integration with the native aorta. This next-generation stent-graft might reduce the risk of migrations and endoleaks, leading to preferable long term results of EVAR.
    Journal of Thoracic and Cardiovascular Surgery 10/2014;
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    ABSTRACT: Objectives Acute acquired hypofibrinogenemia in children undergoing cardiac surgery is a major concern because often results in perioperative bleeding and high rates of allogeneic blood transfusion. Fibrinogen concentrate has been proposed as an alternative to the gold standard therapy cryoprecipitate, with minimal infectious and immunological risks. Our objective was to investigate the efficacy and safety of fibrinogen concentrate in children undergoing cardiac surgery. Methods In this randomised pilot study, patients were allocated to receive fibrinogen concentrate (60 or cryoprecipitate (10 if bleeding was associated to fibrinogen levels <1 g.dL-1 after cardiopulmonary bypass weaning. The primary outcome was postoperative blood losses during 48 h after surgery. Results A total of 63 patients were included in the study, 30 in fibrinogen concentrate group and 33 in cryoprecipitate group. The median 48 hour blood loss was not significantly different between the two groups (320 mL [IQR 157–750] vs. 410 mL [IQR 215–510], respectively, P=0.672). After treatment, plasma fibrinogen concentration increased similarly following administration of both products. There were no differences in allogeneic blood transfusion after intervention treatment. Conclusion A large trial comparing fibrinogen concentrate and cryoprecipitate in the management of children with acute acquired hypofibrinogenemia during heart surgery is feasible. The preliminary results of our study showed that the use of fibrinogen concentrate was as efficient and safe as cryoprecipitate in the management of bleeding children undergoing cardiac surgery.
    Journal of Thoracic and Cardiovascular Surgery 10/2014;
  • Journal of Thoracic and Cardiovascular Surgery 10/2014;
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    ABSTRACT: 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.
    Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1694-9.
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    ABSTRACT: Objective For stage I NSCLC, the only two prognostic factors incorporated in the 7th edition TNM staging system are tumor size and visceral pleural invasion. However, under this current staging system, prognostic precision of survival has proven elusive, suggesting the need to include additional prognostic factors. In order to improve prognostic applications and treatment decisions, we investigated clinicopathologic factors affecting progression-free survival in surgically resected stage I NSCLC patients. Methods Between January 2004 and December 2011, we retrospectively reviewed the clinicopathological characteristics of 758 consecutive surgically resected stage I NSCLC patients at National Taiwan University Hospital. Results The 5-year progression-free survival rate was 82.3% and 64.0% among stage Ia (n=481) and stage Ib (n=277) patients, respectively. Multivariate analysis revealed poor or moderate histological differentiation and elevated preoperative serum CEA value were statistically significant risk factor for recurrence in stage Ia patients, whereas poor or moderate histological differentiation, elevated preoperative serum CEA value, lymphovascular invasion and tumor of > 2 cm were all found to be statistically significant risk factors for recurrence in stage I patients. The 5-year progression-free survival rate was 93.0%, 73.8%, and 40.6% in stage I patients with no risk factor, one or two risk factors, and more than two risk factors, respectively (P<0.001). Conclusions In addition to tumor size, we identified three other independent risk factors for recurrence in stage I NSCLC patients. These three risk factors warrant consideration as additional predictors in the next version of AJCC staging system.
    Journal of Thoracic and Cardiovascular Surgery 10/2014;
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    ABSTRACT: To identify surgical revascularization techniques that minimize surgical risk and maximize late survival in patients with diabetes undergoing coronary artery bypass grafting (CABG).
    Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1257-1266.e9.
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    ABSTRACT: Objective The aim of our study was to develop a novel monitoring system for spinal cord blood flow (SCBF) to test the efficacy of the SCBF sensor in an animal model. Methods The sensor system consisted of two optical fibers, a pedestal for fiber fixation and a mirror for the laser reflection, and was incorporated into a cerebrospinal fluid drainage catheter. In vivo studies were performed in a swine model (n=10) to measure SCBF during spinal cord ischemia induced by clamping the descending thoracic aorta and supra-aortic neck vessels when necessary. Temporary low cardiac output model was also created by inflow clamping of inferior vena cava (IVC) to analyze quantitative changes in SCBF during this maneuver. Results The developed SCBF monitoring catheter placed intrathecally could detect SCBF in all the animals. SCBF after aortic cross-clamping at the 4th intercostal level exhibited diverse changes reproducibly among the animals; more than 25% reduction in SCBF in 5 animals, an increase in 3 and no significant changes in 2, whereas, consistent reductions were recorded during IVC occlusion. Mean SCBF decreased by 32% following IVC occlusion, when cardiac output decreased by 27%. Conclusions We have developed the novel SCBF sensor that could detect real-time changes in the spinal cord perfusion in a swine model. The device holds promise to detect imminent ischemia or assure acceptable blood perfusion in the spinal cord and may further enhance our understanding of circulation in the spinal cord.
    Journal of Thoracic and Cardiovascular Surgery 10/2014;
  • Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1253-6.
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    ABSTRACT: Objectives Recent advances in technology and improved patient management have enabled the use of mechanical circulatory support for unexpected long-term periods. Improved long-term outcomes may facilitate the use of device therapy as an alternative to heart transplantation. However, there are scarce data about the long-term outcomes of continuous-flow left ventricular assist devices (CF-LVADs). This study sought to evaluate the long-term outcomes in patients receivingCF-LVADs. Methods Between March 2004 and June 2010, 140 patients underwent CF-LVAD insertion either as a bridge to transplantation (BTT) or as a destination therapy (DT). These patients’ charts were retrospectively reviewed. Results The initial strategy for CF-LVAD therapy was BTT in 115 (82%) and DT in 25 (18%). Of those, 24 (17%) patients died on LVAD support, 94 (67%) were successfully bridged to transplantation, and one (0.71%) showed native heart recovery. Twenty-four patients (17%) had been on CF-LVAD support for >3 years (mean, 3.9 years; range, 3.0–7.5 years). Estimated on-device survival rates at 1, 3, and 5 years were 83%, 75%, and 61%, respectively. Rehospitalizations due to bleeding, cardiac events, and device-related issues were common. The freedom from rehospitalization rates at 1 and 3 years were 31% and 6.9%, respectively. A total of 14 (10%) patients required device exchange. Conclusions Current CF-LVAD can provide satisfactory long-term survival. However, rehospitalization is frequently required.
    Journal of Thoracic and Cardiovascular Surgery 10/2014;
  • Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):e200-2.
  • Journal of Thoracic and Cardiovascular Surgery 10/2014; 148(4):1147-8.