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Background Surgical repair of a descending thoracic and thoracoabdominal aortic aneurysm (DTA/TAAA) involving the distal arch is challenging and requires either deep hypothermic circulatory arrest (DHCA) or crossclamping of the distal arch. The aim of this study was to compare these 2 techniques in the treatment of DTA/TAAA involving the distal arch. Methods From 1994 to 2012, 298 patients underwent open repair of DTA/TAAA through a left thoracotomy. One hundred seventy-four patients with distal arch involvement who were suitable for either DHCA (n = 81) or arch clamping (AC; n = 93), were analyzed. In-hospital outcomes were compared using propensity scores and inverse-probability-of-treatment weighting adjustment to reduce treatment selection bias. Results Early mortality was 11.1% in the DHCA group and 8.6% in the AC group (P = .58). Major adverse outcomes included stroke in 16 patients (9.2%), low cardiac output syndrome in 15 (8.6%), paraplegia in 10 (5.7%), and multiorgan failure in 10 (5.7%). After adjustment, patients who underwent DHCA were at similar risk of death (odds ratio [OR], 1.14; P = .80) and permanent neurologic injury (OR, 0.95; P = .92) to those who underwent AC. Although prolonged ventilator support (>24 hours) was more frequent with DHCA than with AC (OR, 2.60; P = .003), DHCA showed a tendency to lower the risk of paraplegia (OR, 0.15; P = .057). Conclusions Compared with AC, DHCA did not increase postoperative mortality and morbidity, except for prolonged ventilator support. However, DHCA may offer superior spinal cord protection to AC during repair of DTA/TAAA involving the distal arch. [ABSTRACT FROM AUTHOR]

Objective: To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. Methods: A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. Results: There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P = .68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% (P = .63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P = .67). Conclusions: A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair. [ABSTRACT FROM AUTHOR]

Background: Colonic self-expanding metallic stenting (SEMS) is widely used for the treatment of malignant colonic obstruction as a bridge to elective surgery. However, the effects of colonic stenting on long-term oncologic outcomes are debatable. This study aimed to compare the long-term oncologic outcomes of preoperative SEMS insertion with those of immediate surgery in patients with obstructing left-sided colorectal cancer. Methods: A cohort of consecutive patients who underwent radical surgery for obstructing left-sided colorectal cancer between 2004 and 2011 in five tertiary referral hospitals were analyzed. Long-term survivals were analyzed and adjusted using the inverse probability of treatment weighting method, based on propensity scores, to reduce selection bias. Results: One hundred and nine patients underwent immediate surgery, and 226 underwent stent insertion before surgery. Disease-free survival did not differ significantly in both the unadjusted population (hazard ratio [HR] 1.063, 95% confidence interval [CI] 0.730-1.548; Log-rank, p = 0.746) and the adjusted population (HR 0.122, 95% CI 0.920-1.987; Log-rank, p = 0.122). Overall survival also did not differ significantly in both the unadjusted population (HR 0.871, 95% CI 0.568-1.334; Log-rank, p = 0.526) and the adjusted population (HR 1.023, 95% CI 0.665-1.572; Log-rank, p = 0.916). Defunctioning stoma formation was less in the SEMS insertion group than immediate surgery group (adjusted, 14.6% vs. 41.3%, p < 0.001). Conclusion: The 'bridge to surgery' strategy using metallic stents was oncologically comparable to immediate surgery in patients with malignant left-sided colorectal obstruction. [ABSTRACT FROM AUTHOR]