Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Metformin's Effects Beyond Ischemia: Evaluating Cardioprotection in Non-Ischemic Myocardium in a Large Animal Model of Coronary and Metabolic Disease.","authors":"Keertana Yalamanchili, Christopher Stone, Kelsey C Muir, Dwight D Harris, Meghamsh Kanuparthy, Frank W Sellke","doi":"10.1016/j.jtcvs.2025.10.004","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.10.004","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the effects of metformin (MET) on non-ischemic myocardium in a large animal model of coronary artery disease (CAD) and metabolic syndrome (MS). While prior work has shown MET improves perfusion and function in ischemic tissue, this study assessed whether its cardioprotective effects extend to non-ischemic regions.</p><p><strong>Methods: </strong>Yorkshire swine (n = 12) were fed a high-fat diet to induce MS, and then underwent ameroid constrictor placement around the left circumflex artery to simulate CAD. Animals received either oral MET (1000 mg/day) or placebo for 7 weeks. Regional myocardial perfusion was assessed via microsphere injections at rest and during pacing. Non-ischemic myocardial tissue was identified using gold microsphere distribution and analyzed using immunoblotting, immunofluorescence, and hemodynamic assessment. Statistical significance was evaluated using Student's t-test or the Mann Whitney U test.</p><p><strong>Results: </strong>Despite no significant changes in perfusion, MET-treated animals demonstrated significantly reduced apoptotic markers (caspase 9, cleaved caspase 9, AIF, BAD; p < 0.05) and increased pBAD/BAD ratios. Pro-survival signaling was enhanced with elevated pAKT/AKT, pmTOR/mTOR, and pAMPK/AMPK ratios (p < 0.05). TUNEL staining confirmed decreased apoptosis histologically. Functionally, MET improved cardiac output, stroke volume, and dV/dt Max in the myocardium (p < 0.05), correlating with reductions in apoptotic signaling.</p><p><strong>Conclusions: </strong>MET was associated with significantly reduced apoptosis and promoted pro-survival signaling in non-ischemic myocardium without altering perfusion. These findings suggest that MET's cardioprotective effects are not limited to ischemic tissue, highlighting its potential role as a systemic therapy for CAD and MS, including as an adjunct in cardiac surgery.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304287","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":"Re-evaluating cardiac surgery and long-term cancer risk-Key gaps and clinical implications.","authors":"Fan Yang","doi":"10.1016/j.jtcvs.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.011","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276382","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: Will TROPION be a CHAMPION in stage I lung cancer?","authors":"Gavitt A Woodard, Brendon M Stiles","doi":"10.1016/j.jtcvs.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.10.009","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287569","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: Symptomatic myocardial bridges -Bridging the unknown.","authors":"Anusha Jegatheeswaran, Ruchika Kamojjala","doi":"10.1016/j.jtcvs.2025.10.005","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.10.005","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281567","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":"Integrin αV Emerges as a Potential Therapeutic Target with Cautionary Implications in Thoracic Aortic Aneurysm and Dissection.","authors":"Sheng-An Su, Yuan Zhu, Zhanzeng Feng, Zhanglong Hu, Jixie Le, Chao Chen, Jian Shen, Shiyu Zhu, Shuang Wu, Hong Ma, Meixiang Xiang, Yao Xie","doi":"10.1016/j.jtcvs.2025.10.006","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.10.006","url":null,"abstract":"<p><strong>Objective: </strong>Thoracic aortic aneurysm (TAA) is a life-threatening condition that predisposes to aortic dissection (AD), yet its underlying pathophysiological mechanisms remain poorly understood.</p><p><strong>Methods: </strong>Tandem mass tag (TMT)-based quantitative proteomics of plasma from type A AD patients was performed to identify dysregulated proteins. The β-aminopropionitrile (BAPN)-induced mouse model was used to experimentally recapitulate TAA progression, with disease mechanisms further characterized through Ribonucleic acid (RNA) sequencing transcriptomics, complemented by comprehensive molecular analyses including immunohistochemistry, immunofluorescence, western blot, co-immunoprecipitation, and bioinformatics integration.</p><p><strong>Results: </strong>Integrin αV and integrin αL were significantly downregulated proteins in plasma samples from patients with type A AD. Integrin αV abundantly expressed in the aortic media, particularly in smooth muscle cells (SMCs), with significantly reduced expression following dissection. Pharmacological inhibition of integrin αV with Cilengitide or SB273005 markedly aggravated ascending TAA development, accompanied by severe disorganization and loss of elastic fibers. Bulk RNA sequencing revealed that integrin αV inhibition exacerbated pro-inflammatory responses during TAA progression. Inhibiting integrin αV disrupted the SMC transition to a contractile phenotype, while STAT1 negatively regulated integrin αV-mediated SMC phenotypic modulation.</p><p><strong>Conclusions: </strong>These findings identify integrin αV as a promising molecular target for TAA intervention. However, they also highlight concerns regarding the clinical use of integrin αV inhibitors, which are currently under investigation in cancer trials, as they may increase the risk of TAA or AD development.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281597","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":"EACTS/STS/AATS Guidelines on temporary mechanical circulatory support in adult cardiac surgery.","authors":"Evgenij V Potapov, Glenn Whitman, Ranjit John, Pia Lanmüller, Zuzana Tucanova, Rakesh C Arora, Pavan Atluri, Eric E C de Waal, Gloria Faerber, Antonio Loforte, Roberto Lorusso, David L S Morales, Ivan Netuka, Francis D Pagani, Can Gollmann-Tepeköylü, Andrew Shaffer, Scott C Silvestry, Louis H Stein, Hiroo Takayama, Steven S L Tsui, Leora T Yarboro, Daniel Zimpfer, Milan Milojevic","doi":"10.1016/j.jtcvs.2025.09.046","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.046","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276195","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":"Long-term Clinical Outcomes of 1020 Open Repairs of Descending Thoracic and Thoracoabdominal Aortic Aneurysms.","authors":"Christopher Lau, Eilon Ram, Lamia Harik, Alexander Gregg, Katherine Krieger, Charles Mack, Mohamed Rahouma, Mario Gaudino, Leonard N Girardi","doi":"10.1016/j.jtcvs.2025.09.051","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.051","url":null,"abstract":"<p><strong>Objective: </strong>To assess long-term survival and operative outcomes of open descending thoracic (DTA) and thoracoabdominal (TAAA) aneurysm repair at a high-volume center.</p><p><strong>Methods: </strong>We identified all consecutive patients undergoing DTA/TAAA repair from 1997-2023 and stratified based on aneurysm extent. Operative outcomes were assessed on univariable and multivariable analysis. Long-term survival was estimated by Kaplan-Meier method.</p><p><strong>Results: </strong>Of 1020 patients, 273 had DTA and 747 had TAAA (53.1%, 18.5%, 20.2%, 7.6%, and 0.5% for extent I-V, respectively). Operative mortality was 4.6%; 5.1% in DTA and 4.4% in TAAA. Incidence of myocardial infarction was 0.5%, stroke 1.8%, tracheostomy 6.9%, dialysis 4.8%, and paraplegia 1.3%. On multivariable analysis, diabetes (OR 2.48[1.20-5.13];p=0.014) and renal insufficiency (OR 3.17[1.63-6.13];p<0.001) were associated with operative mortality. Among TAAA, extent II aneurysm (OR 3.56[1.59-7.96]; p=0.002) was associated with operative mortality. Median follow-up was 6.72(95% CI 5.73-7.81) years. Five- and 10-year survival were 67.2% and 48.2% for DTA and 69.9% and 47.5% for TAAA, respectively. Among TAAA, extent I was 76.4% and 49.4%, extent II 62.5% and 43.3%, extent III 60.1% and 45.6%, and extent IV 72.6% and 47.4%, respectively. Age (HR 1.04[1.02-1.05];p<0.001), COPD (HR 1.55[1.25-1.92];p<0.001), diabetes (HR 1.5[1.09-2.07];p=0.013), renal insufficiency (HR 1.47[1.18-1.85]; p<0.001), shock (HR 1.83[1.19-2.81]; p=0.006), and urgent/emergent surgery (HR 1.27[1.03-1.58]; p=0.027) were associated with long-term mortality.</p><p><strong>Conclusions: </strong>At experienced centers, operative outcomes and long-term survival after open DTA/TAAA repair are encouraging. Short-term outcomes are dependent on preoperative risk factors and aneurysm extent. Long-term survival is dependent on age and chronic comorbidities.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276353","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":"Risk of Reoperation Following Rheumatic Mitral Repair: Long-term Longitudinal Analysis.","authors":"Masafumi Shibata, Kitae Kim, Yoshikazu Ono, Hong Rae Kim, Ho Jin Kim, Jae Suk Yoo, Sung-Ho Jung, Jae Won Lee, Joon Bum Kim","doi":"10.1016/j.jtcvs.2025.09.049","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.049","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate long-term outcomes of rheumatic mitral valve (MV) repair and identify the risk factors of MV reoperation.</p><p><strong>Methods: </strong>This retrospective, single center cohort study evaluated 337 patients who underwent MV repair for rheumatic disease from 2000 to 2022. The primary outcome was MV reoperation. Competing risk analyses utilizing Fine-Gray models were performed with death as the competing risk.</p><p><strong>Results: </strong>MV repair techniques included ring-annuloplasty (81.0%), commissure procedures (33.5%), leaflet resection (2.7%), posterior mitral leaflet mobilization (14.8%), anterior mitral leaflet (AMVL) augmentation (4.2%), Alfieri procedure (2.7%), papillary muscle splitting (12.8%), and chordal procedures (30.6%). The 30-day mortality rate was 0.9%. Over a median follow-up of 15.2 years (IQR 7.7-19.4 years; total 4629.71 patient-years), 54 patients died, with a 20-year survival of 78.9% (95% CI, 73.6-84.5%). Thirty-two patients required MV reoperation for regurgitation (n=15), stenosis (MS) (n=14), and mixed lesions (n=3). The cumulative risks of reoperation at 10 and 20 years were 4.5% and 12.7%, respectively. Independent risk factors included tricuspid regurgitation velocity>3.4 m/s (HR 3.26, p=0.005), moderate-to-severe MS (HR 4.39, p<0.001), AMVL augmentation (HR 5.84, p=0.001), and chordal procedures (HR 2.99, p = 0.004). The 20-year reoperation rates were 1.0%, 12.7%, and 33.6% in patients with 0, 1, and ≧ 2 risk factors, respectively (p<0.001).</p><p><strong>Conclusions: </strong>The long-term durability of rheumatic MV repair is significantly affected by risk factors such as pulmonary hypertension, moderate-to-severe MS, AMVL augmentation, and chordal procedures. Repair is preferable in patients without these risk factors.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259781","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":"Outcomes Among Patients Bridged to Heart Transplant with Microaxial Flow Versus Durable Left Ventricular Assist Device Support.","authors":"Alejandro Alvarez, Krish C Dewan, Carmelo A Milano, Oliver K Jawitz, Abigail R Benkert, Jacqueline K Olive, Allison Berryan, Isabella Peralta, Chetan B Patel, Richa Agarwal, Adam D DeVore, Sharon McCartney, Jacob N Schroder, Jeffrey E Keenan","doi":"10.1016/j.jtcvs.2025.09.050","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.050","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate characteristics and outcomes of patients bridged to OHT with microaxial (ma-LVAD) versus durable (d-LVAD) left ventricular assist devices.</p><p><strong>Methods: </strong>This was a single-center retrospective cohort study in which characteristics outcomes of patients undergoing OHT between May 2019 and May 2024 who were bridged with ma-LVAD versus d-LVAD, were compared.</p><p><strong>Results: </strong>Over the study period, the percentage of patients bridged with ma-LVAD increased from 0% to 20%. Patients bridged with d-LVAD were more likely to have history of hypertension (80% vs 65%; p=0.03), a higher BMI (32.53 kg/m2 vs 28.15 kg/m2; p=<0.0001), and anti-HLA antibodies (54% vs 36%; p=0.02) prior to transplant, otherwise groups were similar in their baseline characteristics. Unadjusted Kaplan-Meier analysis demonstrated no difference in survival between these two bridging strategies. However, postoperative blood product usage (3 units vs 0 units, p<0.0001), moderate or severe primary graft dysfunction (27% vs 14%; p=0.04), and delayed sternal closure (45% vs 9%, p=<0.0001) were all higher among those bridged with d-LVAD versus ma-LVAD. Rejection on the first postoperative biopsy was reported in a 60% in the d-LVAD group versus 33% in the ma-LVAD group (p=0.0006). Postoperative intensive care unit (7 days vs 6 days, p=0.03) and overall postoperative length of stay (17 days vs 12 days, p=0.002) were greater in patients bridged with d-LVAD versus ma-LVAD, respectively.</p><p><strong>Conclusion: </strong>The use of ma-LVAD compared to d-LVAD as a bridging strategy was not associated with differences in survival. However, bridging with ma-LVAD compared to d-LVAD was associated with lower post-OHT morbidity.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259749","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":"Refining surgical decision-making for high-risk stage IA Non-Small cell lung cancer.","authors":"Qiang Wu, Zhe Fan, Hao Su, Ting Lei","doi":"10.1016/j.jtcvs.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.009","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240490","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}