Seminars in Thoracic and Cardiovascular Surgery最新文献_第6页

Prognostic Predictors of Tricuspid Regurgitation Worsening after Mitral Regurgitation Surgery with Mild Tricuspid Regurgitation 轻度三尖瓣反流的二尖瓣反流手术后三尖瓣反流恶化的预后预测因素

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2023.03.003

{"title":"Prognostic Predictors of Tricuspid Regurgitation Worsening after Mitral Regurgitation Surgery with Mild Tricuspid Regurgitation","authors":"","doi":"10.1053/j.semtcvs.2023.03.003","DOIUrl":"10.1053/j.semtcvs.2023.03.003","url":null,"abstract":"<div>We aimed to investigate the prevalence and predictors of postoperative tricuspid regurgitation (TR) worsening in patients with mitral regurgitation (MR) and concomitant ≤mild TR. A total of 620 patients underwent surgery for MR from 2013 to 2017. Of these, 260 had ≤mild preoperative TR and no concomitant tricuspid valve surgery and were enrolled in this single-center retrospective study. The primary endpoint was postoperative worsening of ≥moderate TR. The primary endpoint occurred in 28 of 260 patients (11%) during the follow-up period [median: 4.1 years (interquartile range: 2.9−6.1 years)]. In the multivariable analysis, age, female sex, and left atrial volume index (LAVI) were significant predictors of the primary outcome during intermediate-term follow-up (age: hazard ratio [HR] 1.05 per 1-year increment, 95% confidence interval [CI] 1.02–1.10, P = 0.003; female sex: HR 3.53, 95% CI 1.61–7.72, P = 0.002; LAVI: HR 1.17 per 10-mL/m2 increment, 95% CI 1.07−1.26, P < 0.001). The optimal LAVI cut-off value for predicting postoperative TR worsening was 79 mL/m2 (area under the curve: 0.69). A high LAVI (>79 mL/m²) was significantly associated with a low rate of freedom from postoperative TR worsening compared with a low LAVI (≤79 mL/m²) (82.6% vs 93.9% at 5 years, respectively; log-rank P = 0.008). In patients with ≤mild preoperative TR and no concomitant tricuspid surgery, the rate of postoperative TR worsening was 11% during intermediate-term follow-up. LA enlargement in patients with MR and ≤mild preoperative TR was significantly associated with postoperative TR worsening.</div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 303-312"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9287916","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}

引用次数: 0

Discussion to: Characterization of Favorable Right Ventricular Dimensions for Optimal Reverse Remodeling following Pulmonary Valve Replacement 讨论到：肺动脉瓣置换术后最佳反向重塑的有利右心室尺寸特征描述

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2022.11.015

引用次数: 0

Characterization of Favorable Right Ventricular Dimensions for Optimal Reverse Remodeling Following Pulmonary Valve Replacement 肺动脉瓣置换术后反向重塑最佳右心室尺寸的特征描述

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2022.11.014

{"title":"Characterization of Favorable Right Ventricular Dimensions for Optimal Reverse Remodeling Following Pulmonary Valve Replacement","authors":"","doi":"10.1053/j.semtcvs.2022.11.014","DOIUrl":"10.1053/j.semtcvs.2022.11.014","url":null,"abstract":"<div>We sought to couple current cardiac magnetic resonance (CMR) thresholds of right ventricular (RV) size and function with longitudinal trajectories of RV recovery, after pulmonary valve replacement (PVR). We aimed to identify optimal timing of PVR and couple CMR-based metrics with contemporaneous echocardiographic metrics. From June 2002 to January 2019, 174 patients with severe pulmonary regurgitation and peak RV outflow tract gradient <30 mm Hg underwent PVR at Cleveland Clinic. Mean age was 35 ± 16 years and 60 (34%) had concomitant tricuspid valve surgery. RV end diastolic area index (RVEDAi) and function metrics were measured by offline image review on preoperative and 794 postoperative echocardiograms. Contemporaneous RV end diastolic volume index (RVEDVi) was assessed on CMR and correlated to RVEDAi. Multiphase nonlinear mixed-effects models were used to analyze the longitudinal change in RV size and function after PVR. RVEDAi was correlated with RVEDVi (P < 0.0001, r = 0.59). RVEDAi decreased slowly over 10 years following PVR. An inflection point at 24 cm2/m2 was noted at 1 year post-PVR and was associated with failure of RV reverse remodeling and RVEDVi ≥150 mL/m2. Compared to patients with preoperative RVEDVi ≥150 mL/m2, patients with RVEDVi <150 mL/m2 had accelerated recovery of longitudinal trajectories of RV size and function metrics on echocardiograms. Reverse remodeling of RV following PVR is an ongoing process. Current accepted threshold values for PVR are associated with greatest RV recovery, suggesting that earlier PVR is warranted. Echocardiography can potentially be utilized in lieu of CMR for surveillance and interventional triage.</div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 345-355"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9231945","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}

引用次数: 0

Midterm Outcomes in Type A Aortic Dissection Repair With and Without Malperfusion in a Hybrid Operating Room 在混合手术室进行有和无灌注不良的 A 型主动脉夹层修复术的中期效果。

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2022.12.003

{"title":"Midterm Outcomes in Type A Aortic Dissection Repair With and Without Malperfusion in a Hybrid Operating Room","authors":"","doi":"10.1053/j.semtcvs.2022.12.003","DOIUrl":"10.1053/j.semtcvs.2022.12.003","url":null,"abstract":"<div>Treatment approach to type A aortic dissection with malperfusion, immediate open aortic repair vs upfront endovascular treatment, remains controversial. From January 2017 to July 2021, 301 consecutive type A repairs were evaluated at our institution. Starting in 2019, all type A aortic dissections were performed in a fixed-fluoroscopy, hybrid operating room. Propensity score matching was used to control baseline patient characteristics between traditional and hybrid operating room approaches. There were 144 patients in the traditional group and 157 in the hybrid group. In the hybrid group, 41% (64/157) underwent intraoperative angiograms, and of those, 58% (37/64) received at least 1 endovascular intervention. Following propensity matching, 125 patients remained in each the traditional and hybrid groups. Thirty-day survival was significantly improved in the hybrid cohort at 96.7% (122/125) as compared to the traditional cohort at 87.2% (109/125) (P = 0.002). There were no significant differences in perioperative paralysis (1.6% vs 1.6%, P > 0.9), new hemodialysis (12% vs 9.6%, P = 0.5), fasciotomy (2.4% vs 5.6%, P = 0.20, and exploratory laparotomy (1.6% vs 4.8%, P = 0.3). The hybrid operating room approach to type A aortic dissection, provides the ability to immediately assess distal malperfusion and perform endovascular interventions at the time of open aortic repair, and is associated with significantly higher 30-day and 2-year survival when compared to a stepwise repair approach in a traditional operating room.</div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 283-291"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9102803","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}

引用次数: 0

Discussion to: Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes 讨论：术中支持策略对内皮损伤和临床肺移植结果的影响术中支持策略对内皮损伤和临床肺移植结果的影响

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2022.09.017

引用次数: 0

Commentary: Time to Move Beyond the Operating Room 评论：是时候超越手术室了

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2022.11.010

引用次数: 0

Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes 术中支持策略对内皮损伤和临床肺移植结果的影响

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2022.09.016

{"title":"Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes","authors":"","doi":"10.1053/j.semtcvs.2022.09.016","DOIUrl":"10.1053/j.semtcvs.2022.09.016","url":null,"abstract":"<div>In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant were collected for Luminex assay to measure endothelial injury biomarkers including syndecan-1 (SYN-1), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9. Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival in the intensive care unit was significantly higher with CPB compared to V-A ECMO and No-Support (P < 0.01). The rate of primary graft dysfunction grade 3 (PGD3) at 72 hours was 60.0% in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and ICAM-1 were significantly higher in recipients who developed PGD3 at 72 hours. SYN-1 levels were also significantly higher in patients who developed acute kidney injury and hepatic dysfunction after transplant. Postoperative, SYN-1 upon intensive care arrival was found to be a significant predictive biomarker of PGD3, acute kidney injury, and hepatic dysfunction following lung transplantation. CPB is associated with higher plasma concentrations of SYN-1, a marker of endothelial glycocalyx degradation, upon arrival to the intensive care unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following lung transplantation. Our data suggests that intraoperative strategies aimed at modulating endothelial injury will help improve lung transplantation outcomes.</div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 3","pages":"Pages 358-368"},"PeriodicalIF":2.6,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10822410","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}

引用次数: 0

Sequential Coronary Artery Bypass Grafts: Flow-based Patency Assessment Criteria 序贯冠状动脉旁路移植术：基于血流的通畅度评估标准

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2024.01.001

引用次数: 0

Recent Articles in AATS Journals 最近在 AATS 期刊上发表的文章

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2024.08.001

引用次数: 0

Commentary: It Is Okay to Leave the Dissected Aortic Root Alone, but no Felt or Bio-Glue Please! 评论：可以不切除剥离的主动脉根部，但请不要使用毛毡或生物胶！

IF 2.6 3区医学

Seminars in Thoracic and Cardiovascular Surgery Pub Date : 2024-09-01 DOI: 10.1053/j.semtcvs.2023.04.001

引用次数: 0