Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Off-Pump Coronary Artery Bypass Grafting is Overutilized","authors":"Allen A. Razavi MD,&nbsp;Jad Malas MD,&nbsp;Aminah Salam MD,&nbsp;Dominic A. Emerson MD,&nbsp;Michael E. Bowdish MD, MS","doi":"10.1053/j.semtcvs.2024.12.001","DOIUrl":"10.1053/j.semtcvs.2024.12.001","url":null,"abstract":"<div><div>Off-pump coronary artery bypass grafting (CABG), developed to avoid the potential complications of cardiopulmonary bypass, remains a subject of debate. Studies have demonstrated that off-pump CABG is associated with higher rates of incomplete revascularization, inferior graft patency, and increased reintervention rates compared to on-pump CABG, leading to worse outcomes. The theoretical neuroprotective and renal-protective benefits associated with off-pump CABG have not been definitively proven, with stroke and renal failure rates similar to those of on-pump CABG in both short- and long-term follow-up. Off-pump CABG presents technical challenges, contributing to a steep learning curve, and its effectiveness is dependent on surgeon and center experience. Lower-volume centers and surgeons performing off-pump CABG have shown increased rates of mortality and reintervention. Despite the potential cost savings by avoiding cardiopulmonary bypass, the need for repeat interventions and associated complications can lead to higher long-term healthcare costs. This paper advocates for a more selective use of off-pump CABG while maintaining on-pump CABG as the standard approach for patients with coronary artery disease.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 43-47"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Arjun Pennathur MD, Co-Chair Writing Committee ,&nbsp;Michael Lanuti MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Raymond H. Mak MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Garrett Walsh MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;James Luketich MD ,&nbsp;Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.10.002","DOIUrl":"10.1053/j.semtcvs.2024.10.002","url":null,"abstract":"<div><h3>Objectives</h3><div>A significant proportion of patients with stage I non–small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published important considerations in determining which patients are considered high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients.</div></div><div><h3>Methods</h3><div>The AATS Clinical Practice Standards Committee assembled an expert panel to review treatment options for high-risk patients with stage I NSCLC. After a systematic search of the literature identification of lung-nodule-related factors to consider in treatment selection, the panel developed expert consensus statements and vignettes using a modified Delphi method. A 75% consensus was required for approval.</div></div><div><h3>Results</h3><div>The expert panel identified sublobar resection, image-guided thermal ablation (IGTA), and stereotactic ablative radiotherapy (SABR), which is also known as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), as modalities applicable in the treatment of high-risk patients with stage I NSCLC. Fourteen statements and 5 vignettes illustrating clinical scenarios were formulated, revised, and ultimately approved.</div></div><div><h3>Conclusion</h3><div>The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients, with SABR being the likely next choice in nonsurgical patients. If possible, obtaining a biopsy is very important prior non-surgical treatment. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 67-74"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Quality Metrics with Enhanced Recovery Pathways in Coronary Artery Bypass Grafting","authors":"Katherine G. Phillips MD,&nbsp;Aubrey Galloway MD,&nbsp;Eugene A. Grossi MD,&nbsp;Daniel Swistel MD,&nbsp;Deane E. Smith III MD,&nbsp;Ralph Mosca MD,&nbsp;Elias Zias MD","doi":"10.1053/j.semtcvs.2025.01.002","DOIUrl":"10.1053/j.semtcvs.2025.01.002","url":null,"abstract":"<div><div>Quality improvement and enhanced recovery initiatives for coronarybypass surgery have reduced complications, shortened hospital stay and recovery times, and improved patient outcomes. Beyond the Society of Thoracic Surgery’s (STS) quality metrics, many other operative measures, such as completeness of revascularization, and patient care measures add quality and value for patients undergoing coronary artery bypass surgery; and Enhanced Recovery after Surgery (ERAS) protocols have improved patient experience and recovery, leading to better outcomes and significant healthcare savings.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 48-57"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.semtcvs.2025.02.001","DOIUrl":"10.1053/j.semtcvs.2025.02.001","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages e1-e4"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791618","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":"Masthead (copyright and information page)","authors":"","doi":"10.1053/S1043-0679(25)00024-3","DOIUrl":"10.1053/S1043-0679(25)00024-3","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Page I"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Sublobar Resection for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Robert E. Merritt MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Garrett Walsh MD ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;Matthew J. Schuchert MD ,&nbsp;Thomas K. Varghese Jr, MD, MS, MBA ,&nbsp;Michael Lanuti MD, MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Raymond H. Mak MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;Arjun Pennathur MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.11.002","DOIUrl":"10.1053/j.semtcvs.2024.11.002","url":null,"abstract":"<div><div>Sublobar resection offers a parenchymal-sparing surgical alternative to lobectomy and includes wedge resection and segmentectomy. Sublobar resection has been historically utilized in high-risk patients with compromised lung function; however, the technique is becoming more prevalent for normal-risk patients with peripheral stage IA non-small cell lung cancer (NSCLC) &lt;2 cm. In this article, we summarize the technique of sublobar resection, the importance of surgical margins and lymph node sampling, patient selection, perioperative complications, outcomes, and the impact of sublobar resection on the quality of life. There is limited data on short-term and long-term outcomes after sublobar resection for stage I NSCLC in high-risk patients. Results from randomized clinical trials (RCTs) of sublobar resection have been variable. We have summarized the results of the ACOSOG Z4032 RCT, which compared outcomes in high-risk patients who underwent sublobar resection alone versus sublobar resection with brachytherapy for stage I NSCLC. In addition, we have summarized recent findings of the CALGB/Alliance 140503 RCT comparing sublobar resection and lobectomy, which suggested that disease-free survival after sublobar resection in patients with small (&lt;2 cm) peripheral stage IA NSCLC was non-inferior to lobectomy, and another RCT (JCOG 0802) of segmentectomy vs. lobectomy for small peripheral clinical stage IA NSCLC, where segmentectomy was associated with better overall survival despite a higher local recurrence rate. Sublobar resection is primarily performed with minimally invasive approaches, including robotic-assisted and video-assisted thoracoscopic techniques. From an oncologic perspective, obtaining adequate surgical margins and performing an adequate lymph node evaluation are critical for good outcomes after sublobar resection.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 99-105"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of the Comparative Studies of Image-Guided Thermal Ablation, Stereotactic Radiosurgery, and Sublobar Resection for Treatment of High-Risk Patients with Stage I Non-Small Cell Lung Cancer","authors":"Arjun Pennathur MD, Co-Chair Writing Committee ,&nbsp;Michael Lanuti MD ,&nbsp;Robert E. Merritt MD ,&nbsp;Andrea Wolf MD, MPH ,&nbsp;Homa Keshavarz PhD ,&nbsp;Billy W. Loo Jr, MD, PhD ,&nbsp;Robert D. Suh MD ,&nbsp;Raymond H. Mak MD ,&nbsp;Alessandro Brunelli MD ,&nbsp;Gerard J. Criner MD ,&nbsp;Peter J. Mazzone MD ,&nbsp;Garrett Walsh MD ,&nbsp;Michael Liptay MD ,&nbsp;Q. Eileen Wafford MSt, MLIS ,&nbsp;Sudish Murthy MD, PhD ,&nbsp;M. Blair Marshall MD ,&nbsp;Betty Tong MD ,&nbsp;Brian Pettiford MD ,&nbsp;Gaetano Rocco MD ,&nbsp;James Luketich MD ,&nbsp;Scott J. Swanson MD, Co-Chair Writing Committee","doi":"10.1053/j.semtcvs.2024.11.003","DOIUrl":"10.1053/j.semtcvs.2024.11.003","url":null,"abstract":"<div><div>The Clinical Practice Standards Committee of the American Association for Thoracic Surgery assembled an expert panel and conducted a systematic review of the literature detailing studies directly comparing treatment options for high-risk patients with stage I non-small cell lung cancer (NSCLC). A systematic search was performed to identify publications comparing outcomes following image-guided thermal ablation (IGTA), stereotactic ablative radiotherapy (SABR; also called stereotactic body radiation therapy [SBRT] and stereotactic radiosurgery [SRS]), and sublobar resection—the main treatment options applicable to high-risk patients with stage I NSCLC. There were no publications detailing completed randomized controlled trials comparing these treatment options. Several retrospective studies with comparisons were identified, some of which used large, population-based registries. The findings of several of these studies are summarized in this Expert Review article. Registry studies comparing IGTA with SABR in propensity-score matched patients with stage I NSCLC found no difference in overall survival. The use of thermal ablation was less frequent and had wider variation depending on geographic region as compared with SABR, however. Studies yielding high-quality data comparing SABR with sublobar resection have been limited. When comparing sublobar resection with IGTA, sublobar resection was associated with superior primary tumor control and overall survival in the retrospective cohort studies. Retrospective comparative studies are difficult to assess due to the inherent biases or treatment selection and the definitions of loco-regional control. Prospective randomized trials are needed to fully evaluate the outcomes of treatment options applicable to high-risk patients with early-stage lung cancer.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 1","pages":"Pages 106-113"},"PeriodicalIF":2.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiothoracic Surgical Trials Network Update","authors":"J. Hunter Mehaffey MD, MSc ,&nbsp;Raymond Strobel MD, MSc ,&nbsp;Benjamin Kramer MD, PhD ,&nbsp;Patrick T. O'Gara MD ,&nbsp;Michael J. Mack MD ,&nbsp;Nirav C. Patel MD ,&nbsp;Brittany A. Zwischenberger MD ,&nbsp;Robert S. Kramer MD ,&nbsp;Annetine C. Gelijns PhD ,&nbsp;Alan Moskowitz MD ,&nbsp;A. Marc Gillinov MD ,&nbsp;Vinay Badhwar MD","doi":"10.1053/j.semtcvs.2024.12.004","DOIUrl":"10.1053/j.semtcvs.2024.12.004","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 303-307"},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECLS-SHOCK Trial","authors":"Guillaume Thery MD, MSc,&nbsp;Pierre-Emmanuel Noly MD, PhD,&nbsp;Yiorgos Alexandros Cavayas MD, MSc,&nbsp;Ismail Bouhout MD, PhD,&nbsp;Philippe Demers MD, MSc, FRCS,&nbsp;Yoan Lamarche MD, MSc","doi":"10.1053/j.semtcvs.2025.01.004","DOIUrl":"10.1053/j.semtcvs.2025.01.004","url":null,"abstract":"<div><div>ECLS-SHOCK is the largest randomized control trial on Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in Acute Myocardial Infarction-related Cardiogenic Shock (AMI-CS). Unfortunately, ECLS-SHOCK failed to demonstrate a reduction of mortality in AMI-CS with VA-ECMO. Interpretation of these findings must account for frequent crossover to VA-ECMO or other temporary mechanical circulatory support (tMCS) devices in the control group, as well as the exceptionally high severity of illness among participants. We detail here point by point what could explain the outcomes and the unanswered questions. In the light of these results, a liberal use of VA-ECMO might be avoided. Further trials are needed to refine patient selection criteria and determine the optimal timing (“sweet-spot”) for VA-ECMO implementation. Current practice and future guidelines will have to take in count ECLS-SHOCK results.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 298-302"},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Going to Long-Term Acute Care After Cardiac Surgery is Not as Good as Going Home","authors":"Ahmed K. Awad MD,&nbsp;Haley Jenkins MD,&nbsp;Fasial Bakaeen MD,&nbsp;Haytham Elgharably MD","doi":"10.1053/j.semtcvs.2025.01.005","DOIUrl":"10.1053/j.semtcvs.2025.01.005","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 293-297"},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143434048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}