Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Predictors of prolonged hospital stay after segmentectomy","authors":"Fatemehsadat Pezeshkian MD ,&nbsp;Rachel Leo BA ,&nbsp;Miles A. McAllister BA ,&nbsp;Anupama Singh MD ,&nbsp;Emanuele Mazzola PhD ,&nbsp;Fatemeh Hooshmand MSc ,&nbsp;Julio Herrera-Zamora MD ,&nbsp;Mia Silvestri BA ,&nbsp;Rafael Ribeiro Barcelos MD ,&nbsp;Raphael Bueno MD ,&nbsp;Paula Ugalde Figueroa MD ,&nbsp;Michael T. Jaklitsch MD ,&nbsp;Scott J. Swanson MD","doi":"10.1016/j.jtcvs.2024.04.021","DOIUrl":"10.1016/j.jtcvs.2024.04.021","url":null,"abstract":"<div><h3>Objective</h3><div>Segmentectomy is becoming the standard of care for small, peripheral non–small cell lung cancer. To improve perioperative management in this population, this study aims to identify factors influencing hospital length of stay after segmentectomy.</div></div><div><h3>Methods</h3><div>Patients who underwent segmentectomy for any indication between January 2018 and May 2023 were identified using a prospectively maintained institutional database. Multivariable logistic regression models were used to estimate associations between clinical features and prolonged (≥3 days) hospital stay. A nomogram was designed to understand better and possibly calculate the individual risk of prolonged hospital stays.</div></div><div><h3>Results</h3><div>In total, 533 cases were included; 337 (63%) were female. Median age was 66 years (interquartile range [IQR], 63-75). The median size of resected lesions was 1.6 cm (IQR, 1.3-2.1 cm). Median hospital stay was 3 days (IQR, 2-4 days). Major adverse events occurred in 31 (5.8%) cases. The 30-day readmission rate was 5.8% (n = 31). There was no 30-day mortality; 90-day mortality was &lt;1%. Patients older than 75 years (odds ratio [OR], 2.01, 95% confidence interval [CI], 1.15-3.57, <em>P</em><span> = .02), those with forced expiratory volume in 1 second &lt;88% predicted (OR, 1.99; 95% CI, 1.38-2.89, </span><em>P</em> &lt; .001), or positive smoking history (OR, 1.72; 95% CI, 1.15-2.60, <em>P</em><span> = .01) were more likely to have prolonged hospital stays after segmentectomy. A nomogram accounting for age, sex, forced expiratory volume in 1 second, body mass index, smoking history, and comorbidities was created to predict the probability of prolonged hospital stay with an area under the receiver operating characteristic curve of 0.66.</span></div></div><div><h3>Conclusions</h3><div>Older patients, those with reduced pulmonary function<span>, and current and past smokers have elevated risk for prolonged hospital stays after segmentectomy. Validation of our nomogram could improve perioperative risk stratification in patients who undergo segmentectomy.</span></div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 420-426"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865670","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":"Commentary: Treating atrial fibrillation in women: Guidelines versus Reality","authors":"Irsa Hasan MD ,&nbsp;Ibrahim Sultan MD","doi":"10.1016/j.jtcvs.2024.07.026","DOIUrl":"10.1016/j.jtcvs.2024.07.026","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 637-638"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762134","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":"Adaptation of cold preservation techniques to partial heart transplant","authors":"V. Reed LaSala MD,&nbsp;Elizabeth M. Cordoves BA,&nbsp;David M. Kalfa MD, PhD","doi":"10.1016/j.jtcvs.2024.08.013","DOIUrl":"10.1016/j.jtcvs.2024.08.013","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 395-399"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037577","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":"Invest in the Future","authors":"","doi":"10.1016/S0022-5223(24)01194-2","DOIUrl":"10.1016/S0022-5223(24)01194-2","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Page 683"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129848","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":"Adult Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(24)01160-7","DOIUrl":"10.1016/S0022-5223(24)01160-7","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Page e13"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143130105","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":"Significance of isolated postoperative atrial fibrillation in thoracic aortic aneurysm repair","authors":"Megan M. Chung BA ,&nbsp;Cheryl Pan BA ,&nbsp;Hideyuki Hayashi MD ,&nbsp;Viswajit Kandula MD ,&nbsp;Yanling Zhao MS ,&nbsp;Dov Levine MD ,&nbsp;Patra Childress MD ,&nbsp;Lauren Sutherland MD ,&nbsp;Syed T. Raza MD, MA ,&nbsp;Paul Kurlansky MD ,&nbsp;Craig R. Smith MD ,&nbsp;Hiroo Takayama MD, PhD","doi":"10.1016/j.jtcvs.2023.12.023","DOIUrl":"10.1016/j.jtcvs.2023.12.023","url":null,"abstract":"<div><h3>Objective</h3><div>Although postoperative atrial fibrillation<span><span> has been shown to be associated with worse survival after thoracic aortic surgery, its effect on outcomes independently from other </span>postoperative complications is not well understood.</span></div></div><div><h3>Methods</h3><div><span>This is a single-center retrospective study of patients who underwent open thoracic aortic aneurysm repair between March 2005 and March 2021. Postoperative atrial fibrillation was defined as new-onset atrial fibrillation that developed during the index hospital stay. Patients with preoperative atrial fibrillation were excluded. Postoperative major complications included </span>reoperation<span><span><span> for bleeding, respiratory failure, </span>acute renal failure, and stroke. Variables associated with postoperative atrial fibrillation were analyzed with multivariable regression. Survival of patients without major complications was compared between patients without atrial fibrillation and patients with postoperative atrial fibrillation after </span>propensity score matching for baseline and intraoperative characteristics.</span></div></div><div><h3>Results</h3><div>Of 1454 patients, 520 (35.8%) were observed to have postoperative atrial fibrillation. Patients with postoperative atrial fibrillation had a higher rate of postoperative major complications than those without atrial fibrillation (20.2% vs 12.2%, <em>P &lt; .</em>001). Ten-year survival was 82.0% in patients with postoperative atrial fibrillation and 87.0% in patients without atrial fibrillation (<em>P = .</em>008). In the cohort of patients without complications, 10-year survival was similar between patients with and without postoperative atrial fibrillation after propensity score matching (83.6% vs 83.8%, <em>P = .</em>75).</div></div><div><h3>Conclusions</h3><div>Postoperative atrial fibrillation is common after open proximal thoracic aortic aneurysm<span> repair. Although development of major postoperative complications is associated with postoperative atrial fibrillation and decreased long-term survival, isolated postoperative atrial fibrillation does not appear to influence long-term survival.</span></div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 617-626.e7"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139375969","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":"Optimized strategy to improve the outcomes of acute type A aortic dissection with malperfusion syndrome","authors":"Shuangkun Chen MD ,&nbsp;Hua Peng MD ,&nbsp;Hui Zhuang MD ,&nbsp;Juxiang Wang MD ,&nbsp;Pianpian Yan MD ,&nbsp;Weiqun Zhang MD ,&nbsp;Weiliang Zheng BS ,&nbsp;Mingyu Li PhD ,&nbsp;Xijie Wu MD, PhD","doi":"10.1016/j.jtcvs.2024.01.006","DOIUrl":"10.1016/j.jtcvs.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><div><span>The mortality of acute type A aortic dissection (ATAAD) with </span>malperfusion syndrome (MPS) is high. However, the management strategy remains controversial. We aimed to evaluate the strategy for MPS at our institution.</div></div><div><h3>Methods</h3><div>Among 724 patients with ATAAD, 167 patients with MPS were treated with immediate central repair (first stage) or an optimized strategy (second stage). In the second stage, the optimized strategy used was based on 6-hour threshold from symptom onset. For MPS with symptom onset within 6 hours, immediate central repair was performed, followed by endovascular reperfusion if malperfusion persisted. With symptom onset beyond 6 hours, individualized delayed central repair was performed. We compared outcomes between the first and second stages.</div></div><div><h3>Results</h3><div>The in-hospital mortality of ATAAD was significantly decreased when the optimized strategy was used (4.3% in the second stage vs 12.5% in the first stage; <em>P</em> &lt; .01). In the second stage, the in-hospital mortality for MPS was decreased (10.2% vs 33.9%; <em>P</em><span> &lt; .01). Moreover, the in-hospital mortality for MPS with symptom onset within 6 hours and beyond 6 hours decreased from 24% to 7.5% and from 41.2% to 11.8%, respectively. The operative mortality of MPS in the second stage was comparable to that in patients without MPS (4.0% vs 2.4%; </span><em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>The optimized strategy significantly improved the outcomes of MPS. The 6-hour threshold from symptom onset could be very useful in determining the timing of central repair. For patients with MPS symptom onset within 6 hours, immediate central repair is reasonable; for those with symptom onset beyond 6 hours, individualized delayed central repair should be considered.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 562-573.e2"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456432","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":"Robotic-assisted extended thymectomy for large resectable thymoma: 21 years’ experience","authors":"Luyu Huang MD ,&nbsp;Zhongmin Li MD ,&nbsp;Feng Li MD ,&nbsp;Hongbin Zhang MD ,&nbsp;Wenqiang Zhang MD ,&nbsp;Aron Elsner MD ,&nbsp;Julia Strauchmann MD ,&nbsp;Marco Nicolas Andreas MD ,&nbsp;Tomasz Dziodzio MD ,&nbsp;Aina Lask MD ,&nbsp;Jens Neudecker MD ,&nbsp;Mahmoud Ismail MD ,&nbsp;Daipeng Xie MD ,&nbsp;Haiyu Zhou MD, PhD ,&nbsp;Andreas Meisel MD, PhD ,&nbsp;Jens-C. Rueckert MD, PhD","doi":"10.1016/j.jtcvs.2024.08.005","DOIUrl":"10.1016/j.jtcvs.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the perioperative and midterm oncological outcomes of robotic-assisted thoracic surgery extended thymectomy for patients with large resectable thymomas compared with small thymomas.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 204 patients with thymomas who underwent robotic-assisted thoracic surgery extended thymectomy between January 2003 and February 2024. Patients were divided into 2 groups based on the thymoma size (5-cm threshold).</div></div><div><h3>Results</h3><div>The study comprised 114 patients (55.9%) in the small thymoma group and 90 patients (44.1%) in the large thymoma group. No significant differences were found between the groups regarding gender, age, proportion of elderly patients, or pathologic high-risk classifications. Apart from a longer operative time (<em>P =</em> .009) in the large thymoma group, no differences were observed between the 2 groups regarding surgical parameters and postoperative outcomes. No deaths occurred within 30 days in either group. During a median follow-up of 61.0 months (95% CI, 48.96-73.04), 4 patients experienced recurrence (1.96%). No significant differences in the 5-year overall survival (<em>P =</em> .25) or recurrence-free survival (<em>P</em> = .43) were observed between groups.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted thoracic surgery extended thymectomy is technically feasible, safe, and effective for treating large resectable thymomas. Moreover, midterm outcomes for patients with completely resected large thymomas were comparable to those with small thymomas during a median follow-up period of up to 5 years.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 469-483.e10"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of macitentan in Fontan-palliated patients: 52-week randomized, placebo-controlled RUBATO Phase 3 trial and open-label extension","authors":"Paul Clift MD ,&nbsp;Felix Berger MD ,&nbsp;Lars Sondergaard MD, MDSc ,&nbsp;Petra Antonova MD ,&nbsp;Patrick Disney MD ,&nbsp;Jeremy Nicolarsen MD ,&nbsp;Jean-Benoît Thambo MD ,&nbsp;Lidia Tomkiewicz Pajak MD ,&nbsp;Jou-kou Wang MD ,&nbsp;Annette Schophuus Jensen MD, PhD ,&nbsp;Michela Efficace MSc ,&nbsp;Michael Friberg PhD ,&nbsp;Diana Haberle PharmD, PhD ,&nbsp;Verena Walter Diplom-Mathematikerin (FH) ,&nbsp;Yves d’Udekem MD","doi":"10.1016/j.jtcvs.2024.08.039","DOIUrl":"10.1016/j.jtcvs.2024.08.039","url":null,"abstract":"<div><h3>Objectives</h3><div>The efficacy and safety of macitentan, an endothelin receptor antagonist, were assessed in a 52-week, prospective, multicenter, double-blind, randomized, placebo-controlled, parallel-group study assessing the efficacy and safety of macitentan in Fontan-palliated adult and adolescent patients (RUBATO-DB) and an open-label extension trial (RUBATO-OL).</div></div><div><h3>Methods</h3><div>Patients aged 12 years and older with New York Heart Association functional class II or III underwent total cavopulmonary connection more than 1 year before screening and showed no signs of Fontan failure/clinical deterioration. In RUBATO-DB, the primary efficacy end point was change in peak oxygen consumption from baseline to week 16; secondary end points were change from baseline over 52 weeks in peak oxygen consumption and change in mean count/minute of daily physical activity via accelerometer from baseline to week 16. Safety was assessed throughout both studies.</div></div><div><h3>Results</h3><div>In RUBATO-DB, 137 patients were randomized to macitentan 10 mg (n = 68) or placebo (n = 69); 92.7% completed 52-week double-blind treatment. At week 16, mean ± SD change in peak oxygen consumption was −0.16 ± 2.86 versus −0.67 ± 2.66 mL/kg/minute with macitentan versus placebo (median unbiased treatment difference estimate, 0.62 mL/kg/minute [99% repeated CI, −0.62 to 1.85]; <em>P</em> = .19). No treatment effect was observed in either of the secondary end points. During RUBATO-DB, most common adverse events with macitentan were headache, nasopharyngitis, and pyrexia. Across RUBATO-DB and RUBATO-OL, most common adverse events were COVID-19, headache, and fatigue. RUBATO-OL was prematurely discontinued because RUBATO-DB did not meet its primary or secondary end point.</div></div><div><h3>Conclusions</h3><div>The primary end point of RUBATO-DB was not met; macitentan did not improve exercise capacity versus placebo in patients with Fontan palliation. Macitentan was generally well tolerated over long-term treatment.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 385-394.e5"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk and reward of surgical aortic valve replacement","authors":"Joseph E. Bavaria MD","doi":"10.1016/j.jtcvs.2024.01.028","DOIUrl":"10.1016/j.jtcvs.2024.01.028","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 595-598"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139566320","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}