Seminars in Thoracic and Cardiovascular Surgery最新文献

{"title":"Identifying Patients Vulnerable to Inadequate Pain Resolution After Cardiac Surgery","authors":"Ian Kelly BS ,&nbsp;Kara Fields MS ,&nbsp;Pankaj Sarin MD ,&nbsp;Amanda Pang BS ,&nbsp;Martin I. Sigurdsson MD, PhD ,&nbsp;Stanton K. Shernan MD ,&nbsp;Amanda A. Fox MD, MPH ,&nbsp;Simon C. Body MBChB, MPH ,&nbsp;Jochen D. Muehlschlegel MD, MMSc, MBA","doi":"10.1053/j.semtcvs.2022.08.010","DOIUrl":"10.1053/j.semtcvs.2022.08.010","url":null,"abstract":"<div><p><span><span>Acute postoperative pain<span> (APOP) is often evaluated through granular parameters, though monitoring postoperative pain using trends may better describe pain state. We investigated acute postoperative pain trajectories in cardiac surgical patients to identify subpopulations of pain resolution and elucidate predictors of problematic pain courses. We examined retrospective data from 2810 cardiac surgical patients at a single center. The k-means algorithm for longitudinal data was used to generate clusters of pain trajectories over the first 5 postoperative days. Patient characteristics were examined for association with cluster membership using ordinal and multinomial </span></span>logistic regression<span>. We identified 3 subgroups of pain resolution after cardiac surgery: 37.7% with good resolution, 44.2% with moderate resolution, and 18.2% exhibiting poor resolution. Type I diabetes (2.04 [1.00–4.16], </span></span><em>p</em> = 0.05), preoperative opioid use (1.65 [1.23–2.22], <em>p</em><span> = 0.001), and illicit drug use (1.89 [1.26–2.83], </span><em>p</em> = 0.002) elevated risk of membership into worse pain trajectory clusters. Female gender (1.72 [1.30–2.27], <em>p</em> &lt; 0.001), depression (1.60 [1.03–2.50], <em>p</em> = 0.04) and chronic pain (3.28 [1.79–5.99], <em>p</em> &lt; 0.001) increased risk of membership in the worst pain resolution cluster. This study defined 3 APOP resolution subgroups based on pain score trend after cardiac surgery and identified factors that predisposed patients to worse resolution. Patients with moderate or poor pain trajectory consumed more opioids and received them for longer before discharge. Future studies are warranted to determine if altering postoperative pain monitoring and management improve postoperative course of patients at risk of moderate or poor pain resolution.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 182-194"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33456399","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":"Palliated Hypoplastic Left Heart Syndrome Patients Experience Superior Waitlist and Comparable Post-Heart Transplant Survival to Non-Single Ventricle Congenital Heart Disease Patients","authors":"Jason W. Greenberg MD,&nbsp;Muhammad Aanish Raees MBBS,&nbsp;Alia Dani MD, MPH,&nbsp;Haleh C. Heydarian MD,&nbsp;Clifford Chin MD,&nbsp;Farhan Zafar MD, MS,&nbsp;David G. Lehenbauer MD,&nbsp;David L.S. Morales MD","doi":"10.1053/j.semtcvs.2022.08.019","DOIUrl":"10.1053/j.semtcvs.2022.08.019","url":null,"abstract":"<div><p><span><span>Congenital heart disease (CHD) is a well-established risk factor for inferior waitlist and post-heart </span>transplant survival<span><span><span> in children. Differences in outcomes between CHD subgroups are understudied. The present study compared outcomes for palliated hypoplastic left heart syndrome (HLHS) patients to other non-single ventricle CHD (non-SVCHD) and non-CHD patients. United Network for Organ Sharing was used to identify children (age &lt; 18) listed for </span>heart transplant in the United States between 2016 and 2021. CHD sub-diagnoses were only available for United Network for Organ Sharing status 1a after 2015, thereby defining the cohort. Waitlist outcomes were studied using competing-risk time-to-event analysis for transplantation, mortality/decompensation, and alive-on-waitlist. Multivariable Cox </span>proportional hazards regression analyses were used to identify factors associated with inferior post-transplant survival. Patients included: palliated-HLHS (</span></span><em>n =</em> 477), non-SVCHD (<em>n =</em> 686), and non-CHD (<em>n =</em> 1261). At listing, Palliated-HLHS patients were older than non-SVCHD (median 2-year [IQR 0-8] vs median 0-year [0-3], respectively) and younger than non-CHD (median 7-year [0-14]) (<em>P &lt;</em> 0.001 vs both), and were more likely to be white (<em>P &lt;</em> 0.01 vs both). Upon time-to-event analysis, rates of waitlist mortality/decompensation rates were greater among non-SVCHD than palliated-HLHS. Post-transplant survival was comparable between palliated-HLHS and non-SVCHD (<em>P =</em> 0.920) but worse compared to non-CHD (<em>P &lt;</em> 0.001). Both palliated-HLHS (HR 2.40 [95% CI 1.68-3.42]) and non-SVSCHD (2.04 [1.39-2.99]) were independently associated with post-transplant mortality. Palliated-HLHS patients with heart failure experience significantly worse post-transplant outcomes than non-CHD but, compared to other CHD patients, experience superior waitlist and comparable post-transplant survival. While a high-risk cohort, HLHS patients can achieve gratifying waitlist and post-transplant survival.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 230-241"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536420","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 (Editors)","authors":"","doi":"10.1053/S1043-0679(24)00048-0","DOIUrl":"https://doi.org/10.1053/S1043-0679(24)00048-0","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Page I"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141242779","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":"Surgical Outcomes After Reconstruction of the Aortomitral Curtain","authors":"Markian Bojko MD, MPH ,&nbsp;Korri S. Hershenhouse MD ,&nbsp;Ramsey S. Elsayed MD ,&nbsp;Brittany Abt MD ,&nbsp;Robbin G. Cohen MD. MMM ,&nbsp;Raymond Lee MD ,&nbsp;Michael E. Bowdish MD, MS ,&nbsp;Vaughn A. Starnes MD","doi":"10.1053/j.semtcvs.2022.11.008","DOIUrl":"10.1053/j.semtcvs.2022.11.008","url":null,"abstract":"<div><p><span><span>Repair of concomitant aortic and mitral valvular disease with involvement of the aortomitral curtain requires a technically complex operation colloquially termed the commando procedure. Surgical outcomes of this procedure are not well described. The objective of this study was to examine outcomes of the commando procedure at our center. We identified all patients undergoing concomitant aortic and </span>mitral valve replacements<span> from 2004–2021. Of 363 patients, 41 underwent reconstruction of the aortomitral curtain. Survival analysis and multivariable modeling were used to examine outcomes and risk factors for mortality. The median age was 52 (IQR 44-71) years. Preoperatively, 4 of 41 (9.8%) patients had renal failure, and 10 of 41 (24.4%) had a stroke. The most common surgical indication was endocarditis in 25 of 41 (61.0%) patients. 25 of 41 (61.0%) patients underwent redo </span></span>sternotomy<span><span>, and 23 of 41 (56.1%) had previous prosthetic valves<span><span>. Operative mortality was 14 of 41 (34.1%), and 8 of 41 (9.5%) patients received a </span>permanent pacemaker. Survival at 1, 3, and 5 years was 55.4% (95% confidence interval (CI), 40.6–75.5%), 50.3% (35.0–72.3%), and 37.7% (19.3–73.9%) respectively. Cox </span></span>proportional hazards regression identified previous sternotomy (HR 4.76, 95% CI 1.21–18.73), and female gender (HR 1.39, 95% CI 1.17–13.82) as risk factors for mortality. Patients undergoing reconstruction of the aortomitral curtain represent a high-risk population with complex surgical indications. Due to high perioperative morbidity and mortality, this procedure should be performed only when necessary. Despite a high up front morbidity burden, outcomes remain favorable for patients who survive the initial hospitalization.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 158-166"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10732712","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":"Force Profiles of Single Ventricle Atrioventricular Leaflets in Response to Annular Dilation and Leaflet Tethering","authors":"Sumanth Kidambi MD ,&nbsp;Stephen C. Moye BS ,&nbsp;James Lee BA ,&nbsp;Teaghan H. Cowles BS ,&nbsp;E. Brandon Strong MS ,&nbsp;Rob Wilkerson BS ,&nbsp;Michael J. Paulsen MD ,&nbsp;Y. Joseph Woo MD ,&nbsp;Michael R. Ma MD","doi":"10.1053/j.semtcvs.2022.09.012","DOIUrl":"10.1053/j.semtcvs.2022.09.012","url":null,"abstract":"<div><p><span>We sought to understand how leaflet forces change in response to annular dilation and leaflet tethering (LT) in single ventricle<span> physiology. Explanted fetal bovine tricuspid valves<span> were sutured onto image-derived annuli and ventricular mounts. Control valves (CON) were secured to a size-matched hypoplastic left heart syndrome (HLHS)-type annulus and compared to: (1) normal tricuspid valves secured to a size-matched saddle-shaped annulus, (2) HLHS-type annulus with LT, (3) HLHS-type annulus with annular dilation (dilation valves), or (4) a combined disease model with both dilation and tethering (disease valves). The specimens were tested in a systemic heart simulator at various single ventricle physiologies. Leaflet forces were measured using optical strain sensors sutured to each leaflet edge. Average force in the anterior leaflet was 43.2% lower in CON compared to normal tricuspid valves (</span></span></span><em>P &lt;</em> 0.001). LT resulted in a 6.6% increase in average forces on the anterior leaflet (<em>P =</em> 0.04), 10.7% increase on the posterior leaflet (<em>P =</em> 0.03), and 14.1% increase on the septal leaflet (<em>P &lt;</em> 0.001). In dilation valves, average septal leaflet forces increased relative to the CON by 42.2% (<em>P =</em> 0.01). In disease valves, average leaflet forces increased by 54.8% in the anterior leaflet (<em>P &lt;</em> 0.001), 37.6% in the posterior leaflet (<em>P =</em> 0.03), and 79.9% in the septal leaflet (<em>P &lt;</em> 0.001). The anterior leaflet experiences the highest forces in the normal tricuspid annulus under single ventricle physiology conditions. Annular dilation resulted in an increase in forces on the septal leaflet and LT resulted in an increase in forces across all 3 leaflets. Annular dilation and LT combined resulted in the largest increase in leaflet forces across all 3 leaflets.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 216-229"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536422","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":"AATS 2021 Virtual Annual Meeting","authors":"","doi":"10.1053/j.semtcvs.2022.09.014","DOIUrl":"10.1053/j.semtcvs.2022.09.014","url":null,"abstract":"","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 228-229"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180826","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":"Benefit of adjuvant chemotherapy for resected pathologic N1 non-small cell lung cancer is unrecognized: A subgroup analysis of the JBR10 trial","authors":"Omar Toubat PhD ,&nbsp;Li Ding MD, MPH ,&nbsp;Keyue Ding PhD ,&nbsp;Sean C. Wightman MD ,&nbsp;Scott M. Atay MD ,&nbsp;Takashi Harano MD ,&nbsp;Anthony W. Kim MD ,&nbsp;Elizabeth A. David MD, MAS","doi":"10.1053/j.semtcvs.2022.10.005","DOIUrl":"10.1053/j.semtcvs.2022.10.005","url":null,"abstract":"<div><p><span>Adjuvant chemotherapy is underutilized in clinical practice, in part, because its anticipated survival benefit is limited. We evaluated the impact of AC on overall and recurrence-free survival among completely resected pN1 </span>NSCLC<span><span><span> patients enrolled in the North American Intergroup phase III (JBR10) trial. A post-hoc subgroup analysis of pN1 NSCLC patients was performed. Participants were randomized to cisplatin+vinorelbine (AC) (n = 118) or observation (n = 116) following complete resection. The primary endpoint was overall survival (OS). The secondary endpoint was recurrence free survival (RFS). Kaplan-Meier methods were used to compare OS and RFS between the two </span>treatment groups. </span>Cox regression was used to identify factors associated with OS and RFS endpoints. Both groups had similar baseline characteristics. AC patients had improved 5-year OS (AC 61.4% vs observation 41.0%, log-rank p = .008) and 5-year RFS (AC 56.2% vs observation 39.9%, log-rank p = .011) rates compared to observation. Cox regression analyses confirmed the OS (HR 0.583, 95% CI 0.402-0.846, p = .005) and RFS (HR 0.573, 95% CI 0.395-0.830, p = .003) benefit associated with AC. AC was associated with a lower risk (HR 0.648, 95% CI 0.435-0.965, p = .0326) and a lower cumulative incidence (Subdistribution Hazard Ratio [SHR], 0.67, 95% CI 0.449-0.999, p = .0498) of lung cancer deaths. In the JBR10 trial, treatment with AC conferred a significant OS and RFS advantage over observation for pN1 NSCLC patients. These data suggest that pN1 NSCLC patients may experience a disproportionately greater clinical benefit from AC than the 6% survival advantage estimated by the LACE meta-analysis.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 2","pages":"Pages 261-270"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40673677","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":"Predictors of Intervention in Acute Type B Aortic Penetrating Ulcer and Intramural Hematoma","authors":"Michele Piazza MD ,&nbsp;Francesco Squizzato MD ,&nbsp;Luca Porcellato MD,&nbsp;Eugenia Casali MD,&nbsp;Franco Grego MD,&nbsp;Michele Antonello PhD","doi":"10.1053/j.semtcvs.2022.07.009","DOIUrl":"10.1053/j.semtcvs.2022.07.009","url":null,"abstract":"&lt;div&gt;&lt;p&gt;We aimed to investigate predictors of intervention of acute type B aortic penetrating ulcer (PAU) and intramural hematoma (IMH). We conducted a retrospective chart review of all patients admitted for acute type B PAU or IMH in a tertiary referral hospital. Indications to intervention were “complicated” (rupture, impending rupture, malperfusion) or “high risk for unfavorable outcome” (refractory hypertension and/or pain despite best medical treatment, morphologic aortic evolution, transition to a new aortic syndrome, or increase in IMH/PAU depth &gt;5 mm) during the acute/subacute phase. The primary outcomes were overall mortality, aortic-related mortality, and freedom from intervention. Time-dependent outcomes were estimated with Kaplan-Meier curves. Cox proportional hazards models&lt;span&gt;&lt;span&gt; were used to identify predictors of intervention and mortality. There were 54 acute aortic syndromes, 37 PAUs and 17 IMHs. Mean age was 69 ± 14 years and 33 patients (62.2%) were male. Six (11.5%) patients had complicated aortic syndromes and underwent urgent repair. Two (3.7%) additional patients developed an impending rupture during the acute phase. Eleven (21.1%) patients were classified as at “high risk” during the initial hospitalization. Overall, 22 (40.7%) patients required an aortic intervention during the initial admission (n = 16, 72.7% during the acute phase; n = 6, 27.3% during the subacute phase). In-hospital mortality was 5.5% (1 PAU and 2 IMH), and was aorta-related in all cases. For IMH, disease extension in &gt;3 aortic zones (HR 1.94, 95%CI 1.17–32.6; p = 0.038) and presence of ulcer-like projections (ULPs) (HR 1.23, 95%CI 1.02–9.41; p = 0.042) were associated with the need for intervention. There were no aortic-related deaths or intervention during the chronic phase. PAU width &gt;20 mm (HR 1.68, 95%CI 1.07–16.08; p = 0.014), PAU depth &gt;15 mm (HR 6.74, 95%CI 1.31–34.18; p = 021), PAU depth/total aortic diameter &gt;0.3 (HR 4.31, 95%CI 1.17–20.32; p = 0.043), and location at the level of the paravisceral aorta (HR 2.24, 95%CI 1.23–4.70; p = 0.035) were significantly associated with need for intervention. Six additional (16.2%) PAUs required intervention during the chronic phase owing to PAU growth. Maximum aortic diameter &gt;35 mm was significantly associated with intervention (HR 1.45, 95%CI 1.00–2.32; p = 0.037). Acute symptomatic type B IMHs and PAUs are characterized by a high risk of complications during the first month from presentation. Morphologic features associated with intervention were IMH with ULPs or extension in more than 3 aortic zones, as well as PAUs with depth&gt;15 mm, width &gt;20 mm, or depth/aortic diameter ratio&gt;0.3. A strict follow-up protocol or consideration for early intervention within 30 days from presentation should be taken into account for these high-risk patients. During the chronic phase imaging follow-up is particularly important for PAUs in order to identify progression to &lt;/span&gt;saccular","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 1-10"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587811","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":"Staged Ventricular Septation in Double-Inlet Ventricle - A Strategy to Avoid Fontan?","authors":"Anagha Prasanna AB ,&nbsp;Rebecca S. Beroukhim MD ,&nbsp;Sunil Ghelani MD ,&nbsp;Eric N. Feins MD ,&nbsp;Pedro J. del Nido MD ,&nbsp;Sitaram M. Emani MD","doi":"10.1053/j.semtcvs.2022.08.014","DOIUrl":"10.1053/j.semtcvs.2022.08.014","url":null,"abstract":"<div><p><span><span><span>Single-stage ventricular septation for double-inlet left or right ventricle<span><span> (DILV or DIRV) has historically been associated with poor outcomes. We hypothesize that staged ventricular septation may demonstrate favorable clinical outcomes to be an alternative to Fontan palliation. This single-center retrospective study reviewed patients with DILV or DIRV who underwent staged ventricular septation between 2015–2021. The strategy involves </span>pulmonary artery banding or </span></span>Norwood procedure<span><span> during infancy (stage 1), followed by partial ventricular septation to anchor the septum, while maintaining systemic RV pressure to avoid septal shift (stage 2). Residual septal defects are closed with pulmonary artery band removal at stage 3. Results are reported as median (interquartile range). Twelve patients underwent partial ventricular septation. At a median follow-up time of 17 months (8–30) after stage 2, there were no interstage deaths or cardiac transplants; LV dysfunction was observed in one patient. </span>Hemodynamic evaluation after stage 2 demonstrated median </span></span>left atrial pressure of 9.5 mm Hg (8.9–11.5), cardiac index of 3.4 L/min/m</span>² (3.2–3.6), and RV and LV indexed end-diastolic volumes of 52 ml/m² (41–67) and 105 ml/m²<span> (81–115), respectively. Five patients have progressed to stage 3; one required pacemaker for complete heart block. Unplanned reintervention was required in 4 patients after stage 1, 2 patients after stage 2, and 3 patients after stage 3. Staged ventricular septation is an alternative to single-ventricle palliation in a subset of double-inlet ventricle patients and is associated with acceptable early outcomes. Further studies are necessary to determine long-term outcomes.</span></p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 91-101"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33458871","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":"A Retrospective Evaluation of Endo-Aortic Balloon Occlusion Compared to External Clamping in Minimally Invasive Mitral Valve Surgery","authors":"Husam H. Balkhy MD ,&nbsp;Eugene A. Grossi MD ,&nbsp;Bob Kiaii MD ,&nbsp;Douglas Murphy MD ,&nbsp;Arnar Geirsson MD ,&nbsp;Sloane Guy MD ,&nbsp;Clifton Lewis MD","doi":"10.1053/j.semtcvs.2022.11.016","DOIUrl":"10.1053/j.semtcvs.2022.11.016","url":null,"abstract":"<div><p><span><span><span><span><span>We compare outcomes of endo-aortic balloon occlusion (EABO) vs external </span>aortic clamping (EAC) </span>in patients<span> undergoing minimally invasive mitral valve surgery (MIMVS) in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. Adults undergoing mitral valve surgery (July 2017–December 2018) were identified within the STS database (N = 60,607). Total 7,978 patients underwent a minimally invasive approach (including robotically assisted). About 1,163 EABO patients were 1:1 propensity-matched to EAC patients using exact matching on age, sex, and type of mitral procedure, and propensity score average matching for 16 other risk indicators. Early outcomes were compared. Categorical variables were compared using </span></span>logistic regression; hospital and </span>intensive care unit<span> length of stay were compared using negative binomial regression. In the matched cohort, mean age was 62 years; 35.9% were female, and 86% underwent mitral valve repair<span>. Cardiopulmonary bypass time was shorter for EABO vs EAC group (125.0 ± 53.0 vs 134.0 ± 67.0 minutes, </span></span></span><em>P</em><span> = 0.0009). There was one aortic dissection in the EAC group and none in the EABO group (</span><em>P</em><span> value &gt; 0.31), and no statistically significant differences in cross-clamp time, major intraoperative bleeding, perioperative mortality, stroke, new onset of atrial fibrillation, postoperative acute kidney injury, success of repair. Median hospital LOS was shorter for EABO vs EAC procedures (4 vs 5 days, </span><em>P</em> &lt; 0.0001). In this large, retrospective, STS database propensity-matched analysis ofpatients undergoing MIMVS, we observed similar safety outcomes for EABO and EAC, including no aortic dissections in the EABO group. The EABO group showed slightly shorter CPB times and hospital LOS.</p></div>","PeriodicalId":48592,"journal":{"name":"Seminars in Thoracic and Cardiovascular Surgery","volume":"36 1","pages":"Pages 27-36"},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9222167","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}