Journal of thoracic disease最新文献

{"title":"Continued implications of the COVID-19 pandemic environment on non-small cell lung cancer characteristics and treatment in the United States.","authors":"Christina M Stuart, Nicole M Mott, Michael R Bronsert, Adam R Dyas, Salvador Rodriguez Franco, Ana L Gleisner, Simran K Randhawa, Elizabeth A David, John D Mitchell, Robert A Meguid","doi":"10.21037/jtd-24-1334","DOIUrl":"10.21037/jtd-24-1334","url":null,"abstract":"<p><strong>Background: </strong>Given the continued disruption of the coronavirus disease 2019 (COVID-19) pandemic throughout 2021, we aimed to assess for continued implications of the altered healthcare landscape on non-small cell lung cancer (NSCLC) presentation and treatment in the second year of the pandemic.</p><p><strong>Methods: </strong>This was a retrospective cohort study using the United States National Cancer Database (2019-2021). Demographic, cancer-related, and treatment variables were compared between patients diagnosed in the pre-pandemic year [2019], pandemic-year-one [2020], and pandemic-year-two [2021]. Multivariate logistic regression was performed to control for the impact of demographics on oncologic variables, and then for the impact of oncologic variables on treatment modalities and outcomes.</p><p><strong>Results: </strong>Of 376,193 NSCLC cases, 135,649 (36.1%) were pre-pandemic, 119,338 (31.7%) were pandemic-year-one, and 121,206 (32.2%) were pandemic-year-two. Compared to the pre-pandemic year, patients diagnosed in pandemic-year-two had risk-adjusted increases in clinical T stage [odds ratio (OR) =1.017; 95% confidence-interval (CI): 1.003-1.031], N stage (OR =1.048; 95% CI: 1.033-1.063), M stage (OR =1.044; 95% CI: 1.028-1.060), and overall stage (OR =1.038; 95% CI: 1.023-1.052). Additionally, compared to the pre-pandemic year, patients diagnosed in pandemic-year-two continue to see risk-adjusted increases in time from diagnosis to staging (OR =1.044; 95% CI: 1.017-1.072), to first treatment (OR =1.143; 95% CI: 1.133-1.154), to surgery (OR =1.117; 95% CI: 1.093-1.141) and to systemic therapy (OR =1.021; 95% CI: 1.924-1.039).</p><p><strong>Conclusions: </strong>Compared to the pre-pandemic year, patients diagnosed with NSCLC in the United States during pandemic-year-two continue to present at later clinical stage and experience delays to treatment. The oncologic and treatment characteristics of NSCLC have not returned to pre-pandemic baseline in the United States, possibly due to compounding delays to diagnosis and treatment and a growing back log of cases.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"150-160"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil-to-lymphocyte ratio and its correlation with tuberculosis infection: a cross-sectional survey based on the NHANES database.","authors":"Yunfeng Sheng, Haibo Hua, Yanfei Cui, Yaping Sun","doi":"10.21037/jtd-24-750","DOIUrl":"10.21037/jtd-24-750","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis infection (TBI) is a major challenge to global public health. Early detection and treatment of TBI are crucial in preventing tuberculosis (TB). Although inflammation is closely linked to the pathogenesis of TBI, the neutrophil-to-lymphocyte ratio (NLR), as a new inflammatory marker, has been less studied with TBI risk. This study was based on the National Health and Nutrition Examination Survey (NHANES) database. We utilized a cross-sectional research method to explore the association between NLR and the risk of adult TBI, aiming to fill the blank in the studying relationship between NLR and TBI risk. Our findings may contribute to providing new biomarkers for the diagnosis and treatment of TBI.</p><p><strong>Methods: </strong>In this cross-sectional research, data from the NHANES database for the periods 1999-2000 and 2011-2012 were pooled for the study, with TBI as the dependent variable and NLR as the independent variable. A total of 2,433 participants were enrolled, including 391 TBI patients and 2,042 non-TBI patients. The inclusion criteria included information from complete blood testing and TBI status assessment. We evaluated demographic characteristics and clinical factors such as body mass index (BMI), smoking, drinking, NLR, and TBI risk. We employed weighted logistic regression to set up a relationship model between NLR and TBI and dissected the association between them through stratified analysis and subgroup analysis with confounding factors adjusted. We also utilized restricted cubic spline (RCS) and Kaplan-Meier (K-M) survival curves to investigate the nonlinear relationship between NLR and TBI, as well as their relationship with survival rates.</p><p><strong>Results: </strong>A total of 2,433 samples were included in this project, with 391 TBI patients and 2,042 non-TBI patients. In the multivariable weighted logistic regression model, an obvious negative association was observed between NLR and TBI risk [odds ratio (OR) <1, P<0.05], and it was substantially influenced by diabetes (P for interaction =0.049). The negative association between NLR and TBI risk was particularly remarkable (P<0.05) in male and hypertensive patients. The RCS curve indicated a potential linear relationship between NLR and TBI risk (P-non-linear =0.9561), with NLR >1.899, OR <1, being a protective factor. The K-M survival curve revealed an obvious linkage between high NLR (>2.328) and increased death risk in TBI patients.</p><p><strong>Conclusions: </strong>NLR is remarkably negatively linked with TBI risk. Patients with excessively high NLR have worse outcomes.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"70-81"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology dynamic of common respiratory virus in spring, 2018-2023 in Guangdong Province, China.","authors":"Yangqianxi Wang, Yong Liu, Jingyi Liang, Jiaxi Sun, Minyi Zhang, Zichen Chang, Yinqiu Guo, Wenting Zeng, Tie Liu, Zhiqi Zeng, Chitin Hon, Zifeng Yang","doi":"10.21037/jtd-23-1638","DOIUrl":"10.21037/jtd-23-1638","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"518-521"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preserved ratio impaired spirometry: clinical, imaging and artificial intelligence perspective.","authors":"Qianxi Jin, Ziwei Zhang, Taohu Zhou, Xiuxiu Zhou, Xin'ang Jiang, Yi Xia, Yu Guan, Shiyuan Liu, Li Fan","doi":"10.21037/jtd-24-1582","DOIUrl":"10.21037/jtd-24-1582","url":null,"abstract":"<p><p>Preserved ratio impaired spirometry (PRISm) is a pulmonary function pattern characterized by a forced expiratory volume in one second (FEV1) to forced vital capacity ratio greater than 0.70, with an FEV1 that is below 80% of the predicted value, even after the use of bronchodilators. PRISm is considered a form of \"Pre-Chronic Obstructive Pulmonary Disease (Pre-COPD)\" within the broader scope of COPD. Clinically, it presents with respiratory symptoms and is more commonly observed in individuals with high body mass index, females, and those who are current smokers. Additionally, it is frequently associated with metabolic disorders and cardiovascular diseases. Regarding prognosis, PRISm shows considerable variation, ranging from improvement in lung function to the development of COPD. In this article, we review the epidemiology, comorbidities, and clinical outcomes of PRISm, with a particular emphasis on the crucial role of imaging assessments, especially computed tomography scans and magnetic resonance imaging (MRI) technology, in diagnosing, evaluating, and predicting the prognosis of PRISm. Comprehensive imaging provides a quantitative evaluation of lung volume, density, airways, and vasculature, while MRI technology can directly quantify ventilation function and pulmonary blood flow. We also emphasize the future potential of X-ray technology in this field. Moreover, the article discusses the application of artificial intelligence, including its role in predicting PRISm subtypes and modeling ventilation function.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"450-460"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after extubation: an open-label randomized crossover study.","authors":"Suharit Visuthisakchai, Patharapan Lersritwimanmaen, Nuttapol Rittayamai","doi":"10.21037/jtd-24-1345","DOIUrl":"10.21037/jtd-24-1345","url":null,"abstract":"<p><strong>Background: </strong>The current technology of high-velocity nasal insufflation (HVNI) can be equipped with an oxygen assist module (OAM) that continuously monitors and automatically adjusts the inspired oxygen fraction (FiO₂) to maintain oxygen saturation by pulse oximetry (SpO₂) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation.</p><p><strong>Methods: </strong>This randomized crossover study enrolled 16 mechanically ventilated subjects who were ready to wean. The subjects were randomized to protocol A (HVNI with OAM for 60 min, followed by conventional HVNI for another 60 min) or protocol B (conventional HVNI for 60 min, followed by HVNI with OAM for another 60 min) after extubation. In HVNI with OAM, the target SpO₂ was set at 94% with a range of 92-98%, temperature of 37 °C and flow rate of 40 L/min. In the conventional HVNI group, the attending physician adjusted the FiO₂ to maintain an SpO₂ of at least 94%. The primary outcome was the time in the SpO₂ range between the two groups. The secondary outcomes included FiO₂, transcutaneous carbon dioxide pressure (PtcCO₂), respiratory rate oxygenation (ROX) index, and hemodynamic variables.</p><p><strong>Results: </strong>HVNI with OAM significantly maintained SpO₂ within the target range compared to conventional HVNI [99.4% (97.4-99.8%) <i>vs.</i> 5.3% (1.5-68.1%); P=0.001]. The use of FiO₂ was significantly lower and the ROX index was significantly higher at the end of the study in the HVNI with OAM group than in the conventional HVNI group [0.22 (0.21-0.25) <i>vs.</i> 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) <i>vs.</i> 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO₂ or hemodynamic variables were observed between the two groups.</p><p><strong>Conclusions: </strong>HVNI with OAM can maintain SpO₂ within the target range while using a lower FiO₂ and providing a higher ROX index than conventional HVNI in patients after extubation.</p><p><strong>Trial registration: </strong>This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"333-343"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sublobectomy versus lobectomy for peripheral small-sized pulmonary mucinous adenocarcinoma.","authors":"Zhen Yang, Fujun Yang, Zhaoxun Li, Hiran C Fernando, Xiang Li, Gening Jiang, Xiao Song","doi":"10.21037/jtd-2024-2096","DOIUrl":"10.21037/jtd-2024-2096","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary mucinous adenocarcinoma (PMA), a rare type of adenocarcinoma, remains controversial in terms of its associated prognosis. We conducted this study to compare the oncological outcomes of lobectomy and sublobectomy for peripheral small-sized PMA.</p><p><strong>Methods: </strong>This retrospective observational study included all patients with peripheral small-sized (≤2 cm) clinical stage IA1-A2 PMA who underwent lobectomy or sublobectomy (with margin distances ≥2 cm or greater than tumor diameter) between January 2015 and December 2018. Recurrence-free survival (RFS) and overall survival (OS) were compared between the lobectomy and sublobectomy groups with Kaplan-Meier curves and log-rank tests.</p><p><strong>Results: </strong>This study examined 279 patients, with 176 cases in the lobectomy group and 103 cases in the sublobectomy group. Recurrence occurred in 8 patients, and 6 patients died. Before and after propensity score matching (PSM), log-rank tests showed no statistical differences between the lobectomy and sublobectomy groups in terms of 5-year RFS (before PSM: 97.0% <i>vs.</i> 98.9%; after PSM: 94.6% <i>vs.</i> 98.9%) or 5-year OS (before PSM: 96.9% <i>vs.</i> 98.8%; after PSM: 94.8% <i>vs.</i> 98.8%), and the recurrence patterns were also similar between the two groups. The incidence of postoperative complications, such as bronchopleural fistula, hydrothorax requiring redrainage, chylothorax, respiratory failure, and pulmonary embolism, also did not differ between the two groups.</p><p><strong>Conclusions: </strong>For peripheral small-sized PMA, sublobectomy yielded an RFS and OS comparable to those of lobectomy.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"390-399"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap: expanding access to minimally invasive thoracic surgery to reduce health disparities.","authors":"Emily June Zolfaghari, Safraz A Hamid, Mara B Antonoff","doi":"10.21037/jtd-2024-1986","DOIUrl":"10.21037/jtd-2024-1986","url":null,"abstract":"","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"516-517"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causal relationship between type II diabetes mellitus, metformin, insulin, gliclazide, and esophageal cancer-insights from two-sample Mendelian randomization study and meta-analysis.","authors":"Ye Lin, Junhuang Lin, Hui Xu, Zhinuan Hong, Mingqiang Kang","doi":"10.21037/jtd-24-1152","DOIUrl":"10.21037/jtd-24-1152","url":null,"abstract":"<p><strong>Background: </strong>Over recent decades, findings on the potential correlation between type II diabetes mellitus (T2DM) and the risk of esophageal cancer (EC) have displayed considerable heterogeneity. Furthermore, metformin has emerged as a potentially protective agent against certain site-specific malignancies. This study aims to explore the causal relationship between T2DM, medication treatments (metformin, insulin, gliclazide), and EC risk while addressing the notable variability in previous research findings.</p><p><strong>Methods: </strong>To elucidate the causal associations between T2DM, medication treatments, and EC, we employed a synergistic methodology that integrates the two-sample Mendelian randomization (MR) approach with meta-analysis. The genome-wide association studies (GWAS) pertaining to each exposure and EC were acquired from a publicly accessible database.</p><p><strong>Results: </strong>For MR analyses, three out of seven GWAS datasets within the T2DM cohort exhibited statistical significance. Conversely, all MR analyses yielded non-significant results in the medication cohort. Meta-analyses suggested that a genetic predisposition to T2DM correlated with a reduced risk of EC [odds ratio (OR), 0.999612; 95% confidence interval (CI): 0.999468-0.999756; P=0.01; I²=0%]. Moreover, metformin intake was causally linked to a decreased prevalence of EC (OR, 0.988954; 95% CI: 0.979044-0.998963; P=0.03; I²=0%), whereas neither insulin nor gliclazide manifests statistical significance.</p><p><strong>Conclusions: </strong>Our findings indicate T2DM and metformin are causally associated with diminished risk of EC, while no causal associations exist between insulin, gliclazide, and EC.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"243-253"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lobectomy <i>vs.</i> bisegmentectomy for lung cancer in the left upper lobe: a retrospective comparative cohort study.","authors":"Hao Liu, Jinjie Yu, Yunfeng Yuan, Klara Schwarzova, Lijie Tan, Hao Zhang, Miao Lin","doi":"10.21037/jtd-2024-2199","DOIUrl":"10.21037/jtd-2024-2199","url":null,"abstract":"<p><strong>Background: </strong>Lobectomy has been established as the standard treatment for resectable non-small cell lung cancer (NSCLC) since the publication of a randomized prospective clinical trial conducted by the Lung Cancer Study Group (LCSG) in the 1990s. However, this study possesses certain drawbacks from a contemporary standpoint. Over the past decades, further studies have been conducted to comprehensively outline appropriate surgical procedures for NSCLC. Segmentectomy is considered a potential alternative for predominant ground-glass opacities (GGOs) or tumors smaller than 2 cm. However, there is limited research regarding their relative benefits. We compared oncological outcomes of patients undergoing left upper lobectomy and a \"multi-segmentectomy\" [trisegmentectomy (S₁₊₂ + S₃) or lingulectomy (S₄ + S₅)] for NSCLC of the left upper lobe, only patients with a pathological stage I-IIIA [according to the 8^th edition of the International Association for the Study of Lung Cancer tumor-node-metastasis (TNM) classification system] were then included in our study. Oncological outcomes, including overall survival (OS) and disease-free survival (DFS), were compared between patients who underwent lobectomy and those who underwent bisegmentectomy.</p><p><strong>Methods: </strong>A retrospective study was performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University, that included patients who underwent lobectomy and bisegmentectomy for NSCLC in the left upper lobe from January 2009 to December 2016. Oncological outcomes, including OS and DFS, were compared between patients who underwent lobectomy and those who underwent bisegmentectomy. Subgroup analyses were completed based on the type of operation and tumor size.</p><p><strong>Results: </strong>A total of 997 patients were included, with 888 undergoing left upper lobectomy, 33 undergoing lingulectomy, and 76 undergoing inherent segmentectomy. After a retrospective comparative cohort study, no significant differences were observed in OS (P=0.49) or DFS (P=0.62) between the lobectomy and bisegmentectomy groups. Subgroup analyses were performed for each type of bisegmentectomy and different tumor sizes. Despite a noted inferior OS in the lingulectomy group (P=0.049), no significant difference in OS or DFS was identified in the other subgroup comparisons (P>0.05).</p><p><strong>Conclusions: </strong>Left upper bisegmentectomy demonstrated comparable oncological outcomes to those of left upper lobectomy, even in cases of larger tumor size (≥2 cm). However, the lingulectomy group exhibited a concerning inferiority in OS, necessitating further evaluation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"400-412"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of concomitant Cox-Maze III procedure in patients with aortic valve diseases and preoperative atrial fibrillation.","authors":"Chan Hyeong Kim, Yoonjin Kang, Ji Seong Kim, Yeiwon Lee, Sue Hyun Kim, Suk Ho Sohn, Ho Young Hwang, Kyung Hwan Kim, Jae Woong Choi","doi":"10.21037/jtd-24-1223","DOIUrl":"10.21037/jtd-24-1223","url":null,"abstract":"<p><strong>Background: </strong>There was limited evidence on the clinical benefits of the concomitant Cox-Maze procedure with aortic valve replacement (AVR) in patients with atrial fibrillation. This study aimed to evaluate the early and long-term results of the concomitant Cox-Maze procedure in patients undergoing AVR for aortic valve disease.</p><p><strong>Methods: </strong>We enrolled 101 patients who underwent AVR and had preoperative atrial fibrillation between January 1994 and December 2020. The early- and long-term clinical outcomes were compared between patients who underwent the concomitant Cox-Maze III procedures and those who did not undergo surgical ablation. Inverse probability of treatment weighting (IPTW) was used to adjust for differences in preoperative characteristics.</p><p><strong>Results: </strong>Forty-seven patients underwent the concomitant Cox-Maze III procedure (CM group), and 54 patients did not undergo surgical ablation for atrial fibrillation (non-CM group). There were no significant differences in early surgical outcomes between the two groups, except for a higher occurrence of acute kidney injury (AKI) in the CM group (P<0.001). The median follow-up duration was 70.7 months (interquartile range 36.2-118.8 months), and there were no significant differences in overall survival, thromboembolic complications, and anticoagulation-related bleeding between the two groups. Atrial fibrillation occurrence was significantly lower (P<0.001) in the CM group, and a greater number of patients discontinued anticoagulation in the CM group compared to the non-CM group (P=0.001).</p><p><strong>Conclusions: </strong>The concomitant Cox-Maze procedure in patients with atrial fibrillation undergoing AVR did not increase early mortality or morbidity, except for AKI, and showed favorable long-term results in terms of rhythm outcome and anticoagulation discontinuation.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"17 1","pages":"369-378"},"PeriodicalIF":2.1,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}