Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Intrathoracic versus cervical anastomosis in esophagectomy: A further discussion.","authors":"Linghan Tian, Chao Ming, Ming Jiang, Jie Zhao","doi":"10.1016/j.jtcvs.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.01.005","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and long-term outcomes of combined organ resection for esophageal cancer invading adjacent organs: Experience of 90 consecutive cases.","authors":"Tomoki Makino, Makoto Yamasaki, Shigeto Nakai, Kota Momose, Kotaro Yamashita, Koji Tanaka, Kazuo Shimamura, Masaaki Motoori, Yukinori Kurokawa, Yutaka Kimura, Kiyokazu Nakajima, Shigeru Miyagawa, Hidetoshi Eguchi, Yuichiro Doki","doi":"10.1016/j.jtcvs.2025.01.017","DOIUrl":"10.1016/j.jtcvs.2025.01.017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility of and long-term survival with combined organ resection for esophageal cancer (EC). The optimal treatment strategy for EC that is invading adjacent organs is not established.</p><p><strong>Methods: </strong>Ninety patients with EC invading adjacent organs who underwent combined organ resection after induction treatments during the time period 2003-2023 in our institute were eligible for the study. Short- and long-term outcomes were assessed, and survival analysis was performed to identify prognostic parameters in this cohort.</p><p><strong>Results: </strong>Most patients had primary tumors (78.9% vs 21.1% with recurrent disease). The resected organs were the trachea/bronchus in 75.6%, large vessels in 24.4%, and both in 5.6%. All but 1 patient underwent chemotherapy or chemoradiotherapy as prior induction treatment, and had R0 resection. The overall complication rate (Clavien-Dindo grade II or greater) was 54.4%, and in-hospital mortality was 2.2% (30- and 90-day mortality: 0% and 2.2%, respectively). Of the deaths, 47 (87.0%) were attributed to EC and 7 (13.0%) to other causes. Median disease-free survival was 6.5 months, and overall survival (OS) was 18.9 months. The 2-year OS values were 47.2% with trachea/bronchus resection, 38.4% with large-vessel involvement, and 37.5% if both were involved. Univariate analysis of OS demonstrated significant associations of operation time (hazard ratio [HR], 2.11; P = .0080), blood loss (HR, 2.85; P = .0003), all-layer tracheal resection (HR, 3.51; P = .0045), ypT (HR, 2.04; P = .022), and pathologic response (HR, 2.77; P = .0089).</p><p><strong>Conclusions: </strong>If patient selection is highly selected, combined organ resection may be a feasible and promising option as a part of the multidisciplinary treatment for EC invading an adjacent organ.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed reality for preoperative planning and intraoperative assistance of surgical correction of complex congenital heart defects.","authors":"Matteo Ponzoni, Francesco Bertelli, Shi-Joon Yoo, Brandon Peel, Hannah Seatle, Osami Honjo, Christoph Haller, David J Barron, Mike Seed, Christopher Z Lam, Aamir Jeewa, Encarnacion Gutierrez Carretero, Antonio Ordonez, Israel Valverde","doi":"10.1016/j.jtcvs.2024.12.034","DOIUrl":"10.1016/j.jtcvs.2024.12.034","url":null,"abstract":"<p><strong>Objectives: </strong>Mixed reality (MixR) is an innovative visualization tool that presents virtual elements in a real-world environment, enabling real-time interaction between the user and the combined digital/physical reality. We aimed to explore the feasibility of MixR in enhancing preoperative planning and intraoperative guidance for the correction of various complex congenital heart defects.</p><p><strong>Methods: </strong>Patients underwent cardiac computed tomography or cardiac magnetic resonance imaging and segmentation of digital imaging and communications in medicine images was performed. Three-dimensional models were then uploaded into a MixR headset (Microsoft HoloLens 2), displayed as holograms, and used for preoperative navigation of cardiac anatomy and intraoperative assistance of surgical steps.</p><p><strong>Results: </strong>We adopted MixR in 5 different clinical scenarios: minimally invasive partial anomalous pulmonary venous connection repair of 5 anomalous veins, intraextracardiac Fontan completion in right atrial isomerism and dextrocardia, arterial switch operation for transposition of the great arteries with abnormal coronary pattern in situs inversus, complete unifocalization of major aortopulmonary collateral arteries, and total artificial heart implantation for failing Fontan. Preoperative MixR allowed a comprehensive understanding of complex anatomical relationships and spatial mapping, using immersive 3-dimensional navigation. As a result, the surgeon was able to simulate the surgical approach and plan the best surgical strategy. Intraoperatively, MixR provided a real-time virtual map by overlaying holograms onto the patient's anatomy.</p><p><strong>Conclusions: </strong>MixR represents a promising tool for preoperative planning and 3-dimensional visualization in patients with complex congenital heart defects; however, its systematic adoption in intraoperative settings requires further implementation of current hardware technology and software versatility.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of atrial fibrillation in coronary artery bypass grafting.","authors":"Sarah Nisivaco, Taras Lysyy, Jane Kruse, James L Cox, S Chris Malaisrie","doi":"10.1016/j.jtcvs.2025.01.014","DOIUrl":"10.1016/j.jtcvs.2025.01.014","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The circulatory arrest recovery ammonia problem (CARAP) hypothesis: A proton magnetic resonance spectroscopy (¹H-MRS) study of brain metabolism during neonatal cardiopulmonary bypass surgery.","authors":"Daniel Spielman, Meng Gu, Hunter Liu, Shie-Chau Liu, Ralph Hurd, Kirk Riemer, Kenichi Okamura, Masafumi Shibata, Paul Shuttleworth, Zachary Kleiman, Karla Epperson, Kevin Epperson, Frank Hanley","doi":"10.1016/j.jtcvs.2025.01.016","DOIUrl":"10.1016/j.jtcvs.2025.01.016","url":null,"abstract":"<p><strong>Objective: </strong>Congenital heart disease affects 1% of US births, with many babies requiring major cardiothoracic surgery under cardiopulmonary bypass (CPB), exposing the more critical patients to neurodevelopmental impairment. Optimal surgical parameters to minimize neuronal injury are unknown. We used proton magnetic resonance spectroscopy (¹H MRS) and blood ammonia assays in a neonatal pig model of CPB to compare 2 approaches, complete circulatory arrest (CA) versus antegrade cerebral perfusion.</p><p><strong>Methods: </strong>Two-week old piglets (N = 17) were put on a CPB pump and placed in a 3-T magnetic resonance imaging to study brain metabolism during CPB. Dynamic single-voxel ¹H MRS brain data were acquired while animals underwent 1 of 4 CPB protocols: ∼50 minutes CA at 18 °C and 28 °C or antegrade cerebral perfusion at 18°C and 28 °C, followed by a ∼1-hour recovery period. On the basis of ¹H MRS findings suggesting the presence of brain ammonia upon reperfusion, a second cohort of piglets (N = 22) underwent the same CPB conditions without MRS to allow regular venous blood sampling with ammonia assays.</p><p><strong>Results: </strong>All animals showed a transitory temperature-dependent increase in blood ammonia (P < .001) immediately after restart of whole-body perfusion. In contrast, metabolic processing of brain ammonia, as detected by an increased ¹H MRS glutamine/glutamate ratio, was also temperature dependent (P = .002) but only significantly observed in the CA studies (P = .009).</p><p><strong>Conclusions: </strong>Serial ¹H-MRS and blood ammonia assays in this preclinical CPB model identified a previously unreported build-up of ammonia, hypothesized to arise from gut bacterial production, after reperfusion, that may contribute to brain injury in these pediatric surgeries.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentator Discussion: Outcomes after hospital discharge in children requiring postcardiotomy extracorporeal membrane oxygenation: A binational retrospective cohort study.","authors":"","doi":"10.1016/j.jtcvs.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.12.022","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentator Discussion: Initial balloon versus surgical valvuloplasty in children with isolated congenital aortic stenosis: Impact on timing of aortic valve replacement.","authors":"","doi":"10.1016/j.jtcvs.2024.12.023","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.12.023","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing innovative artificial intelligence algorithms to assess echocardiographic videos for clinical modeling.","authors":"Sidrah Laldin, Cedrique Shum-Tim, Satya Prakash, Dominique Shum-Tim","doi":"10.1016/j.jtcvs.2025.01.008","DOIUrl":"10.1016/j.jtcvs.2025.01.008","url":null,"abstract":"<p><strong>Objective: </strong>To use multiple dynamic deep learning algorithms to develop predictive models with video-based echocardiographic images using sample size determination as a key variable to assess optimal performance metrics.</p><p><strong>Methods: </strong>Our study compares performance of 3-dimensional convolutional neural networks, video vision transformers, and hybrid convolutional neural networks and long short-term memory models within both supervised learning and semi-supervised learning (SSL) domains using variable sample sizes.</p><p><strong>Results: </strong>For supervised learning, the ResNet3D model achieved the lowest mean absolute error (MAE) and root mean squared error (RMSE) across all training set sizes (200-, 400-, and 800-video datasets), with the best performance observed on the 800-video training set (MAE = 7.409, RMSE = 10.216). In the SSL setting, both the ResNet3D and ResNet+LSTM models benefited from the inclusion of unlabeled data, particularly with larger data sets.</p><p><strong>Conclusions: </strong>Because SSL models use both labeled and unlabeled data sets, our findings are significant in showing that performance of certain predictive models using mixtures of unlabeled and labeled data is comparable to that of models using only labeled data with similar sample sizes, thus obviating the need for large sample sizes of labeled data.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating safety and outcomes of living allogenic heart valve transplantation: The case for a multicenter prospective clinical registry.","authors":"Elizabeth M Cordoves, V Reed LaSala, Alexander C Gregg, Mario F L Gaudino, David M Overman, William M deCampli, Christopher A Caldarone, Eugene Blackstone, Tara Karamlou, Marc E Richmond, Douglas Overbey, Joseph W Turek, Emile A Bacha, David M Kalfa","doi":"10.1016/j.jtcvs.2025.01.011","DOIUrl":"10.1016/j.jtcvs.2025.01.011","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-five years of the ross operation in adults: The inclusion technique keeps up the expectations.","authors":"Federica Caldaroni, Peter Skillington, Michael O'Keefe, Edward Buratto, Rochelle Wynne","doi":"10.1016/j.jtcvs.2025.01.007","DOIUrl":"10.1016/j.jtcvs.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>In adults, the Ross procedure provides an excellent alternative to prosthetic valves, but it is underutilized because of concerns about technical complexity, durability, and perceived high late reoperation rates. The inclusion technique stabilizes the aortic root, prevents dilatation, and respects the dynamic root physiology. Long-term outcomes of the Ross procedure with the inclusion cylinder technique (1992-2022) are reported.</p><p><strong>Methods: </strong>Long-term (12.2 years; 95% CI, 11.5-12.8) single institution results, with more than 25 years of follow-up in 44 patients. A total of 516 patients aged 39 ± 13 years underwent Ross procedure with inclusion cylinder and annular reduction. All had yearly clinical review and biannual transthoracic echocardiogram. The etiology of valve disease comprised aortic stenosis (AS) (n = 233 [44.8%]), aortic regurgitation (AR) (n = 179 [34.4%]), and mixed AS/AR (n = 108 [20.8%]). The primary end points were 25-year survival and freedom from reoperation, with degree of autograft regurgitation in all morphologies (AS, AR, and mixed AR/AS) as the secondary end point.</p><p><strong>Results: </strong>Total reoperation rate was 8.3% after 25 years (n = 43; aortic valve = 28, pulmonary valve 15), with early reoperation (<1 year) in 0.6% and early postoperative death in 0.2% following myocardial infarction. Overall, 25-year survival was 85.3%, and 25-year freedom from autograft reoperation was 89.5% (AS = 95.0%, AR = 78.0%, and mixed AS/AR = 94.3%) (P = .01). Freedom from redo pulmonary valve replacement was 92.7%.</p><p><strong>Conclusions: </strong>The Ross procedure with inclusion cylinder technique provides excellent hemodynamics. Autograft inclusion in the native aorta minimizes prosthetic material and respects physiological root changes, reducing shear stress on neoaortic cusps and increasing durability. Long-term reoperation rate is low in experienced centers.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}