Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Commentator Discussion: Preoperatively predicting survival outcome for clinical stage IA pure-solid non-small cell lung cancer by radiomics-based machine learning.","authors":"","doi":"10.1016/j.jtcvs.2024.07.004","DOIUrl":"10.1016/j.jtcvs.2024.07.004","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"267-268"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793936","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":"Reply: Achieving environmental justice will reduce lung cancer health disparities.","authors":"Hollis Hutchings, Haroutioun Boyajian, Ikenna Okereke","doi":"10.1016/j.jtcvs.2024.08.032","DOIUrl":"10.1016/j.jtcvs.2024.08.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"e8-e9"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479293","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 impact of multimodal analgesia in coronary artery bypass graft surgery-a population-based analysis.","authors":"Crispiana Cozowicz, Haoyan Zhong, Jashvant Poeran, Alex Illescas, Jiabin Liu, Lazaros A Poultsides, Dimitrios V Avgerinos, Stavros G Memtsoudis","doi":"10.1016/j.jtcvs.2023.11.035","DOIUrl":"10.1016/j.jtcvs.2023.11.035","url":null,"abstract":"<p><strong>Objective: </strong>Multimodal pain management aims to concurrently target several pain pathways for improved treatment efficacy and recovery. We investigated associations between multimodal analgesia use and postoperative complications, length of hospital stay (LOS), and opioid consumption among patients undergoing coronary artery bypass graft surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 349,940 adult patients undergoing elective coronary artery bypass graft surgery (January 2006 to December 2019), from the national Premier Healthcare claims dataset. The study intervention was multimodal analgesia, defined as opioid use with the addition of nonopioid analgesic modalities. These included, nonsteroidal anti-inflammatory drugs, cyclooxygenase-2 inhibitors, paracetamol/acetaminophen, neuraxial anesthesia, steroids, gabapentin/pregabalin, and ketamine. Analgesic management was stratified into 4 categories: opioids only and multimodal analgesia with the addition of 1, 2 or ≥3 nonopioid analgesic modalities. Mixed-effects regression models measured associations between multimodal analgesia and postoperative complications, LOS, and opioid consumption measured in milligram oral morphine equivalents.</p><p><strong>Results: </strong>Multimodal analgesia was associated with a beneficial dose response pattern. With increasing nonopioid analgesic modalities added to opioid analgesia, a stepwise decrease in complication risk was consistently observed, eg, with the addition of 1, 2, or ≥3 nonopioid modalities the odds for any complication decreased by 8% (odds ratio [OR], 0.92; confidence interval [CI], 0.90-0.94), 17% (OR, 0.83; CI, 0.81-0.86), and 22% (OR, 0.78; CI 0.69-0.79), respectively. This stepwise pattern was consistent in respiratory, cardiac, and renal complications individually. Similarly, LOS decreased stepwise with added analgesic modalities.</p><p><strong>Conclusions: </strong>These nationally representative data indicate that enhanced pain management by multiple pain pathways is associated with significant reductions in postoperative complications and shortened patient recovery.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"105-113.e5"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138479125","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":"Discussion to: Unplanned readmissions, community socioeconomic factors, and their effects on long-term survival after complex thoracic aortic surgery.","authors":"","doi":"10.1016/j.jtcvs.2024.02.002","DOIUrl":"10.1016/j.jtcvs.2024.02.002","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"36-37"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061032","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":"Severe truncal valve insufficiency and biventricular hypertrophy in a low birth weight neonate.","authors":"Igor E Konstantinov","doi":"10.1016/j.jtcvs.2024.09.012","DOIUrl":"10.1016/j.jtcvs.2024.09.012","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"e3-e6"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299603","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: Coronary anatomy in arterial switch: Does it matter?","authors":"Igor E Konstantinov, Tyson A Fricke","doi":"10.1016/j.jtcvs.2024.08.001","DOIUrl":"10.1016/j.jtcvs.2024.08.001","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"229-230"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903342","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":"Changes in heart transplant outcomes of elderly patients in the new allocation era.","authors":"Zachary W Sollie, Jennie H Kwon, Benjamin Usry, Khaled Shorbaji, Brett A Welch, Zubair A Hashmi, Lucas Witer, Nicolas Pope, Ryan J Tedford, Arman Kilic","doi":"10.1016/j.jtcvs.2024.03.015","DOIUrl":"10.1016/j.jtcvs.2024.03.015","url":null,"abstract":"<p><strong>Objective: </strong>Studies demonstrate that heart transplantation can be performed safely in septuagenarians. We evaluate the outcomes of septuagenarians undergoing heart transplantation after the US heart allocation change in 2018.</p><p><strong>Methods: </strong>The United Network for Organ Sharing registry was used to identify heart transplant recipients aged 70 years or more between 2010 and 2021. Primary outcomes were 90-day and 1-year mortality. Kaplan-Meier, multivariable Cox proportional hazards, and accelerated failure time models were used for unadjusted and risk-adjusted analyses.</p><p><strong>Results: </strong>A total of 27,403 patients underwent heart transplantation, with 1059 (3.9%) aged 70 years or more. Patients aged 70 years or more increased from 3.7% before 2018 to 4.5% after 2018 (P = .003). Patients aged 70 years or more before 2018 had comparable 90-day and 1-year survivals relative to patients aged less than 70 years (90 days: 93.8% vs 94.2%, log-rank P = .650; 1 year: 89.4% vs 91.1%, log-rank P = .130). After 2018, septuagenarians had lower 90-day and 1-year survivals (90 days: 91.4% vs 95.0%, log-rank P = .021; 1 year: 86.5% vs 90.9%, log-rank P = .018). Risk-adjusted analysis showed comparable 90-day mortality (hazard ratio, 1.29; 0.94-1.76, P = .110) but worse 1-year mortality (hazard ratio, 1.32; 1.03-1.68, P = .028) before policy change. After policy change, both 90-day and 1-year mortalities were higher (90 days: HR, 1.99; 1.23-3.22, P = .005; 1 year: hazard ratio, 1.71; 1.14-2.56, P = .010). An accelerated failure time model showed comparable 90-day (0.42; 0.16-1.44; P = .088) and 1-year (0.48; 0.18-1.26; P = .133) survival postallocation change.</p><p><strong>Conclusions: </strong>Septuagenarians comprise a greater proportion of heart transplant recipients after the allocation change, and their post-transplant outcomes relative to younger recipients have worsened.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"134-145.e1"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140190366","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 debulking of large ventricular fibromas in children.","authors":"Ajami Gikandi, Peter Chiu, Jordan Secor, Meena Nathan, Edward O'Leary, Edward Walsh, Tal Geva, Rebecca Beroukhim, Pedro Del Nido","doi":"10.1016/j.jtcvs.2024.05.013","DOIUrl":"10.1016/j.jtcvs.2024.05.013","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to provide an update on the clinical presentation, diagnostic workup, operative strategies, and midterm outcomes in children undergoing ventricular fibroma resection.</p><p><strong>Methods: </strong>Single-center, retrospective cohort study of patients undergoing ventricular fibroma resection between 2000 and 2023.</p><p><strong>Results: </strong>Among 52 patients, median age at surgery was 2.0 years (interquartile range, 0.8-4.6) and median tumor volume index was 69 mL/m² (interquartile range, 49-169). Tumor distorted the atrioventricular valve/subvalvar apparatus in 30 patients (58%) and abutted major epicardial coronary arteries in 41 patients (79%). Surgery was indicated for arrythmia (n = 45, 86%), symptoms (n = 14, 27%), or hemodynamic compromise (n = 11, 21%). Tumor was debulked in 34 patients (65%), including the last 21 patients. Concomitant atrioventricular valvuloplasty was performed in 18 patients and ventricular cavity closure in 15 patients (29%). During a median follow-up of 2.4 years (interquartile range, 0.8-6.2), there was no mortality, cardiac arrests, heart transplants, or single ventricle palliation. The 15-year risk of reoperation and clinical ventricular tachycardia/fibrillation was 6.7% (95% CI, 0-14.3) and 2.4% (95% CI, 0-7.2), respectively. On latest imaging, pre- and postdebulking left ventricular ejection fraction did not significantly differ (P = .069), whereas no patients had signs of outflow tract obstruction, inflow tract obstruction, or moderate or greater atrioventricular valve regurgitation.</p><p><strong>Conclusions: </strong>Large ventricular fibromas can be resected safely with appropriate surgical planning and an emphasis on debulking. Most children maintain left ventricular function and remain free of recurrent ventricular arrhythmias at follow-up. Extended follow-up is warranted to understand whether patients remain at risk for scar-based ventricular arrhythmias in the future.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"186-194"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141159022","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":"Harmonizing guidelines and other clinical practice documents: A joint comprehensive methodology manual by the American Association for Thoracic Surgery (AATS), European Association for Cardio-Thoracic Surgery (EACTS), European Society of Thoracic Surgeons (ESTS), and Society of Thoracic Surgeons (STS).","authors":"Milan Milojevic, Nick Freemantle, J W Awori Hayanga, Rosemary F Kelly, Patrick O Myers, René Horsleben Petersen, Isabelle Opitz, Joseph F Sabik, Faisal G Bakaeen","doi":"10.1016/j.jtcvs.2024.07.048","DOIUrl":"10.1016/j.jtcvs.2024.07.048","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"170-185"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479288","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":"Machine learning and decision making in aortic arch repair.","authors":"Rashmi Nedadur, Nitish Bhatt, Jennifer Chung, Michael W A Chu, Maral Ouzounian, Bo Wang","doi":"10.1016/j.jtcvs.2023.11.032","DOIUrl":"10.1016/j.jtcvs.2023.11.032","url":null,"abstract":"<p><strong>Background: </strong>Decision making during aortic arch surgery regarding cannulation strategy and nadir temperature are important in reducing risk, and there is a need to determine the best individualized strategy in a data-driven fashion. Using machine learning (ML), we modeled the risk of death or stroke in elective aortic arch surgery based on patient characteristics and intraoperative decisions.</p><p><strong>Methods: </strong>The study cohort comprised 1323 patients from 9 institutions who underwent an elective aortic arch procedure between 2002 and 2021. A total of 69 variables were used in developing a logistic regression and XGBoost ML model trained for binary classification of mortality and stroke. Shapely additive explanations (SHAP) values were studied to determine the importance of intraoperative decisions.</p><p><strong>Results: </strong>During the study period, 3.9% of patients died and 5.4% experienced stroke. XGBoost (area under the curve [AUC], 0.77 for death, 0.87 for stroke) demonstrated better discrimination than logistic regression (AUC, 0.65 for death, 0.75 for stroke). From SHAP analysis, intraoperative decisions are 3 of the top 20 predictors of death and 6 of the top 20 predictors of stroke. Predictor weights are patient-specific and reflect the patient's preoperative characteristics and other intraoperative decisions. Patient-level simulation also demonstrates the variable contribution of each decision in the context of the other choices that are made.</p><p><strong>Conclusions: </strong>Using ML, we can more accurately identify patients at risk of death and stroke, as well as the strategy that better reduces the risk of adverse events compared to traditional prediction models. Operative decisions made may be tailored based on a patient's specific characteristics, allowing for maximized, personalized benefit.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":"59-67.e4"},"PeriodicalIF":4.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138452965","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}