Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Discussions in Cardiothoracic Treatment and Care: Implications for the Composite Allocation Score System for Organ Distribution in the United States","authors":"Jacob A. Klapper MD, FACS , Chadrick Denlinger MD , Matthew G. Hartwig MD, MHS , Stephanie H. Chang MD, MSCI","doi":"10.1053/j.semtcvs.2024.08.002","DOIUrl":"10.1053/j.semtcvs.2024.08.002","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 450-456"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116911","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":"Discussions in Cardiothoracic Treatment and Care: Towards Robust and Trustworthy Coronary Guidelines","authors":"Faisal G. Bakaeen MD , Joseph F. Sabik MD , Patrick O. Myers MD , Dawn S. Hui MD , Milan Milojevic MD, PhD","doi":"10.1053/j.semtcvs.2024.08.003","DOIUrl":"10.1053/j.semtcvs.2024.08.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 411-417"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116910","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":"Aortic Valve Surgery in Children With Infective Endocarditis","authors":"Damien M. Wu MD ,&nbsp;Michael Z.L. Zhu MBBS ,&nbsp;Edward Buratto MBBS, PhD, FRACS ,&nbsp;Christian P. Brizard MD, MS ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1053/j.semtcvs.2023.02.004","DOIUrl":"10.1053/j.semtcvs.2023.02.004","url":null,"abstract":"<div><div><span>There is limited data on the outcomes of children who undergo surgery for aortic valve<span><span> infective endocarditis (IE), and the optimal surgical approach remains controversial. We investigated the long-term outcomes of surgery for aortic valve IE in children, with a particular focus on the Ross procedure<span>. A retrospective review of all children who underwent surgery for aortic valve IE was performed at a single institution. Between 1989 and 2020, 41 children underwent surgery for aortic valve IE, of whom 16 (39.0%) underwent valve repair, 13 (31.7%) underwent the Ross procedure, 9 (21.9%) underwent a </span></span>homograft<span><span> root replacement, and 3 (7.3%) underwent a mechanical valve replacement. Median age was 10.1 years (interquartile range, 5.4–14.1). The majority of children (82.9%, 34/41) had underlying congenital heart disease, while 39.0% (16/41) had previous heart surgery. </span>Operative mortality was 0.0% (0/16) for repair, 15.4% (2/13) for the Ross procedure, 33.3% (3/9) for homograft root replacement, and 33.3% (1/3) for mechanical replacement. Survival at 10 years was 87.5% for repair, 74.1% for Ross, and 66.7% for homograft (</span></span></span><em>P</em><span> &gt; 0.05). Freedom from reoperation at 10 years was 30.8% for repair, 63.0% for Ross, and 26.3% for homograft (</span><em>P</em> = 0.15 for Ross vs repair, <em>P</em> = 0.002 for Ross vs homograft). Children undergoing surgery for aortic valve IE have acceptable long-term survival, although the need for long-term reintervention is significant. The Ross procedure appears to be the optimal choice when repair is not feasible.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 418-427"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9620453","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":"Initial Management Strategy and Long-Term Outcomes in 186 Cases of Spontaneous Coronary Artery Dissection","authors":"","doi":"10.1053/j.semtcvs.2023.05.003","DOIUrl":"10.1053/j.semtcvs.2023.05.003","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 396-397"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169871","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":"Making the Transition From Cardiac Missions to Autonomous Heart Surgery at a Nigerian Teaching Hospital: Challenges and Lessons Learned","authors":"Bode Falase FRCS CTh ,&nbsp;Setemi Olufemi FWACS CTh ,&nbsp;Funmilayo Ikotun FWACS ,&nbsp;Folasade Daniel FMCP ,&nbsp;Ariyo Idowu PGCert Perfusion ,&nbsp;Reza Khodaverdian MD ,&nbsp;Emily Farkas MD","doi":"10.1053/j.semtcvs.2023.05.002","DOIUrl":"10.1053/j.semtcvs.2023.05.002","url":null,"abstract":"<div><div><span><span>Open-Heart Surgery at the Lagos State University Teaching Hospital commenced in 2004. Early years were based on a Cardiac Mission Model, but since 2017 the focus was on the transition to a Local Team Model with autonomous Open-Heart Surgery. The aim of this study is to describe our progress in making this transition, highlight lessons learned, and detail the outstanding challenges to be overcome. This study is a retrospective analysis of prospectively maintained data from the Lagos State University Teaching Hospital cardiothoracic database and Nigeria Open-Heart Surgery Registry between November 2004 and December 2021. Data extracted included patient demographics, </span>EuroSCORE II, operative procedure, operative category, lead surgeon, complications, and outcomes. Over the study period, 100 operations were done over 2 time periods, 51 operations between 2004 and 2011 (Cardiac Mission Period) and 49 operations between 2017 and 2021 (Transition Period). In the Cardiac Mission Period, 21.6% of the operations were done by the Local Team and in the Transition Period this increased to 85.7% of the operations completed. Overall mortality was 14%, dropping from 17.6% in the Cardiac Mission Period to 10.2% in the Transition Period. The Local Team is now gradually taking on more diverse cases while striving to maintain good outcomes. Our institution has successfully made the transition from Cardiac Missions to Autonomous Open-Heart Surgery without an increase in mortality and a gradual increase in surgical volumes. Lessons learned included a strategy to focus on adult surgery, avoidance of high-risk cases, and moving from free surgery toward an appropriate cost structure for program sustainability. Contributory factors to the successful transition include the active support of the </span>hospital management (provision of appropriate infrastructure and equipment, investment in training of the Local Team), continued humanitarian international collaborations focused on skill transfer, and maintenance of Local Team skills by collaborations with other active cardiac centers in Nigeria. Remaining challenges include financing to bridge equipment gaps, maintenance and replacement of equipment as well as the evolution of a national health insurance schema that would ideally support Open-Heart Surgery for Nigerian patients. Until that time, patients and programs must rely on supplemental funding of surgery to increase surgical volumes.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 398-410"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9927257","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":"Lung Transplantation for COVID-19 Acute Respiratory Distress Syndrome: The British Columbian Experience With New Disease Pathology","authors":"Roy Avraham Hilzenrat MD, MHSc ,&nbsp;John C. English MD ,&nbsp;Anna McGuire MD, MSc ,&nbsp;Gordon Finlayson MD ,&nbsp;James Choi MD, MPH ,&nbsp;John Yee MD","doi":"10.1053/j.semtcvs.2022.12.004","DOIUrl":"10.1053/j.semtcvs.2022.12.004","url":null,"abstract":"<div><div>Lung transplantation is a life-saving treatment for patients with end-stage lung disease. COVID-19 has been associated with a severe and rapid decline in pulmonary function, in which case lung transplantation has been described to be effective. We herein describe 9 patients who underwent lung transplantation for COVID-19 acute respiratory distress syndrome, of whom 6 were bridged with extracorporeal membrane oxygenation (ECMO). The median time of pre-operative observation periods was 54 days to ensure no lung function recovery and the time to wean off extracorporeal membrane oxygenation was 3 days. Patients had comparable short-term survival outcomes to non-COVID-19 lung transplant recipients at our institution during the same time period. Lung transplantation for COVID-19-associated lung disease is feasible with comparable short-term outcomes and may liberate patients from extracorporeal supports.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 4","pages":"Pages 445-449"},"PeriodicalIF":2.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10530112","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":"Implications of the Composite Allocation Score System for Lung Transplantation in the United States: Review of the New System","authors":"Isaac S. Alderete MHS ,&nbsp;Cathlyn K. Medina BA ,&nbsp;Samantha E. Halpern MD MHS ,&nbsp;Arya Pontula BSPH ,&nbsp;Matthew G. Hartwig MD MHS","doi":"10.1053/j.semtcvs.2024.09.001","DOIUrl":"10.1053/j.semtcvs.2024.09.001","url":null,"abstract":"<div><div>Due to criticism regarding undue adherence to fixed geographic boundaries, the Lung Allocation Score system was recently replaced by the more holistic allocation via continuous distribution. This review highlights the historical evolution of US lung allocation paradigms, outlines rationale for continuous distribution under the Composite Allocation Score system and discusses expected implications of this new system.</div></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"37 3","pages":"Pages 329-333"},"PeriodicalIF":2.5,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356345","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":"Masthead (copyright and information page)","authors":"","doi":"10.1053/S1043-0679(24)00058-3","DOIUrl":"10.1053/S1043-0679(24)00058-3","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Page I"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167352","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":"Skilled Nursing Facility Quality Rating and Surgical Outcomes Following Coronary Artery Bypass Grafting","authors":"","doi":"10.1053/j.semtcvs.2022.11.007","DOIUrl":"10.1053/j.semtcvs.2022.11.007","url":null,"abstract":"<div><p><span>Centers for Medicare and Medicaid Services created a 5-star quality rating system to evaluate skilled nursing facilities (SNFs). Patient discharge to lower-star quality SNFs has been shown to adversely impact surgical outcomes. Recent data has shown that over 20% of patients are discharged to an SNF after CABG, but the link between SNF quality and CABG outcomes has not been established. The purpose of this study is to evaluate the impact of SNF quality ratings on postoperative outcomes after CABG. Retrospective cohort review of Medicare patients undergoing CABG and discharged to an SNF between the years 2016-2017. Patients were categorized into 3 groups according to the star rating of the SNF with receipt of care after discharge (ie, below average, average, above average). Risk-adjusted 30-day to 1-year outcomes of mortality, readmission, and SNF length of stay were calculated and compared using multivariable logistic regression and Poisson models across SNF quality categories. Of the 73,164 Medicare patients in our sample, 15,522 (21.2%) were discharged to an SNF. Patients in below average SNFs were more likely to be younger, Black, Medicare/Medicaid dual eligible, and have more comorbidities. Compared to above average SNFs, patients discharged to below average SNFs experienced higher risk-adjusted 30-day mortality (2.1% vs 1.6%, </span><em>P</em>&lt;0.02), readmission (21.6% vs 19.3%, <em>P</em>&lt;0.01) and SNF length of stay (17.3d vs 16.5d, <em>P</em>&lt;0.0001). Within 90-days, below average SNFs experienced higher risk-adjusted readmission rates (31.7% vs 30.0%, <em>P</em>&lt;0.004). Outcomes at 1-year were not statistically significant. Medicare beneficiaries discharged to lower quality SNFs experienced worse postoperative outcomes after CABG. Identifying best practices at high performing SNFs, to potentially implement at low performing facilities, may improve equitable care for patients.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 313-320"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10336182","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":"Homelessness and Race are Mortality Predictors in US Veterans Undergoing CABG","authors":"","doi":"10.1053/j.semtcvs.2022.10.001","DOIUrl":"10.1053/j.semtcvs.2022.10.001","url":null,"abstract":"<div><p><span><span>Coronary artery disease<span> requiring surgical revascularization is prevalent in United States Veterans. We aimed to investigate preoperative predictors of 30-day mortality following </span></span>coronary artery bypass grafting<span><span> (CABG) in the Veteran population. The Veterans Affairs Surgical Quality Improvement (VASQIP) national database was queried for isolated CABG cases between 2008 and 2018. The primary outcome was 30-day mortality. A multivariable </span>logistic regression was performed to assess for independent predictors of the primary outcome. A </span></span><em>P</em><span><span><span>-value of &lt;0.05 was considered statistically significant. A total of 32,711 patients were included. The 30-day mortality rate<span> was 1.37%. Multivariable analysis identified the following predictors of 30-day mortality: African-American race (OR 1.46, 95% CI 1.09-1.96); homelessness (OR 6.49, 95% CI 3.39-12.45); female sex (OR 2.15, 95% CI 1.08-4.30); preoperative myocardial infarction within 7 days (OR 1.49, 95% CI 1.06-2.10) or more than 7 days before CABG (OR 1.34, 95% CI 1.04-1.72); partially/fully dependent functional status (OR 1.44, 95% CI 1.07-1.93); </span></span>chronic obstructive pulmonary disease<span><span> (OR 1.54, 95% CI 1.24-1.92); mild (OR 1.48, 95% CI 1.04-2.11) and severe aortic stenosis (OR 2.06, 95% CI 1.37-3.09); moderate (OR 1.88, 95% CI 1.31-2.72), or severe (OR 2.99, 95% CI 1.71-5.22) </span>mitral regurgitation<span>; cardiomegaly (OR 1.73, 95% CI 1.35-2.22); </span></span></span>NYHA Class III/IV heart failure (OR 2.05, 95% CI 1.10-3.83); and urgent/emergent operation (OR 1.42, 95% CI 1.08-1.87). The 30-day mortality rate in US Veterans undergoing isolated CABG between 2008 and 2018 was 1.37%. In addition to established clinical factors, African-American race and homelessness were independent demographic predictors of 30-day mortality.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 323-332"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33501308","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}