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Background: Patients with clinically/pathologically diagnosed stage IIIa non-small cell lung cancer (NSCLC) considered for surgery are recommended to undergo neoadjuvant chemotherapy with or without radiation. The timing of an operation after therapy is not standardized; therefore, we investigated the timing of intervention after neoadjuvant therapy and the impact on outcomes in this demographic., Methods: The National Cancer Database was queried between 2010 and 2015 for patients with clinical/pathologic stage IIIa NSCLC. Patients were then divided into short (<77 days), mid (77-114 days), and long delay (>114 days) groups based on interquartile values. These groups were then compared for age, race, gender, insurance type, Charlson-Deyo score, length of stay, readmission rate, and overall survival based on timing of operation., Results: There were 31,357 patients with clinical/pathologic stage IIIa NSCLC, and 5946 patients underwent surgical intervention. Preoperatively 3593 patients underwent chemoradiotherapy, 2185 underwent chemotherapy only, and 168 received radiation alone. The short, mid, and long delay groups were clinically and statistically similar in age, gender, insurance type, comorbidity index, treating facility type, and distance from home. Long delay groups had larger tumor size compared with other groups. Postoperative length of stay, rates of 30-day readmission, and 30- and 90-day mortality were similar across all groups. Cox modeling demonstrated a significant difference in survival when patients underwent earlier operative intervention compared with late operative intervention and when patients received chemoradiation compared with chemotherapy alone. Short, mid, and long delay group 1-year survivals were 82%, 83%, and 80% and 3-year survival 59%, 58%, and 52%, respectively (P = .0003)., Conclusions: The delay in surgical resection of stage IIIa NSCLC is not associated increased early mortality; however, it is associated with worse 3-year postresection survival., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: There is no objective method to estimate post-lung transplant survival solely on the basis of cumulative donor risk factors., Methods: The United Network Organ Sharing thoracic transplant database was queried to identify patients who underwent lung transplantation between 2005 and 2015. A Cox proportional hazard model was generated using a training set to identify donor risk factors significantly associated with posttransplant survival. Significant donor risk factors were assigned a score on the basis of their hazard ratio. Donor risk score was calculated for each patient by adding the individual donor risk factor scores. Donors in the validation set were then categorized into low-risk (score = 0), intermediate-risk (score = 1), and high-risk (score >1) categories on the basis of the cumulative risk score. The Lung Allocation Score was used as a surrogate for recipient risk. Survival for each risk group was calculated using Kaplan-Meier curves., Results: The donor risk groups' respective survival at 1 year was 85%, 81%, and 77%, and at 5 years it was 53%, 50%, and 42% (p < 0.001). The combination of low-risk recipients and low-risk donors had 1- and 5-year survival of 89% and 59%, respectively. The combination of high-risk recipients and high-risk donors had 1- and 5-year survival of 70% and 30%, respectively., Conclusions: The proposed lung donor scoring system is a simple, easy to use method that can aid transplant surgeons in the selection of a potential lung transplant donor. Using the lung donor score in conjunction with the Lung Allocation Score can allow for matching of recipients and donors, to optimize posttransplant outcomes., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: Surgical repair of acute Type A aortic dissection (AADA) is still associated with high in-hospital mortality. We evaluated the impact of perioperative risk factors on early and midterm survival., Methods: Retrospective (2002-2011) database analysis at a single institution of 132 consecutive AADA patients (88 male, age 59.8 ± 13.6). All but five patients underwent repair with open distal anastomoses and hypothermic circulatory arrest: aortic valve replacement/root replacement (n=44, 33.3%) and valve re-suspension/repair (n=88, 66.7%). Ascending aorta, hemi-arch, and total arch repairs were performed in 11, 113, and eight patients, respectively. Antegrade and retrograde cerebral perfusion were used in all but six patients., Results: Overall in-hospital mortality was 17.4% (n=23). Actuarial survival at one, five, and eight years was 82%, 72%, and 62%, respectively. Perfusion time (cardiopulmonary bypass) (226.5 ± 71.3 vs. 177.5 ± 51.7, p=0.0002), aortic cross-clamp time (min) (132.8 ± 45.7 vs. 109.8 ± 41.2, p=0.01), aortic arch (T2) tear (31% vs. 14%, p=0.03), instability (26% vs. 11%, p=0.02), postoperative stroke (38% vs. 14%, p=0.009), and low cardiac output (50% vs. 15%, p=0.04) all correlated with increased perioperative mortality. A Cox proportional hazard model showed perfusion time (hazard ratio [HR]=1.01), postoperative stroke (HR=2.73), age (HR=1.03), and unstability (HR=1.8) as significant risk factors (p<0.05) affecting the overall survival., Conclusion: There is a modern trend towards improving overall perioperative outcomes after surgical repair of AADA; however, early mortality and morbidity remain high even in aortic surgery referral centers., (© 2013 Wiley Periodicals, Inc.)

Background: Porcine bioprosthesis (bioroots) are an attractive surgical strategy for ascending aorta and arch replacement. This study evaluated the perioperative and late outcomes using this strategy for proximal aortic aneurysmal disease., Methods: Between March 1998 and November 2009, 170 patients (40% women; median age, 70 years) underwent proximal thoracic aortic replacement using the Freestyle (Medtronics Inc, Minneapolis, MN) bioroot, with graft extension in 149 (87.6%). Aneurysmal etiology included degenerative-atherosclerotic (91.2%), acute dissection (5.3%), and chronic dissection (3.5%); 78% had greater than moderate aortic insufficiency. Surgical procedures were bioroot alone or with aortoplasty (12.3%), bioroot with ascending aortic graft (38.2%), bioroot with hemiarch graft (44.1%), and bioroot with total arch (5.3%). Hypothermic circulatory arrest was required in 49%., Results: The 30-day mortality was 4.7% (n=8). The overall complication rate was 58% (n=100), including stroke (6.5%), renal failure (9.2%), respiratory failure (25.9%), and postoperative bleeding (7.6%). Mean hospitalization was 10.5±7.3 days; 38 were discharged to a rehabilitation facility (23.5%). Predictors of 30-day/hospital death were coronary artery disease (p=0.0003), renal insufficiency (p<0.0001), emergent/urgent procedure (p=0.02), and hypothermic circulatory arrest (p=0.002). The 1-year, 5-year, and 10-year survivals were 90%, 80%, and 35% respectively. Freedom from endocarditis and reoperation was 96% at 1 year and 94% and 95% at 5 years, respectively., Conclusions: Proximal thoracic aortic replacement using a porcine bioroot as part of the repair can be achieved with low perioperative mortality and acceptable late survival in a predominantly elderly population., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)