Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Extracellular Vesicles in Lung Donor Plasma: Potential Indicators of Donor Organ Quality.","authors":"SeoJeong Joo, Kishor Dhaygude, Rainer Krebs, Emil Holmström, Maija Puhka, Saara Laitinen, Göran Dellgren, Jesper Magnusson, Erik C Holmberg, Johan Svahn, Thomas Kromann Lund, Inga Leuckfeld, Peter Raivio, Ilkka Helanterä, Fredrik Åberg, Simo O Syrjälä, Antti I Nykänen, Karl B Lemström","doi":"10.1016/j.jtcvs.2025.03.012","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.03.012","url":null,"abstract":"<p><strong>Objective: </strong>Brain death induces systemic inflammation and hemodynamic changes that can lead to lung injury, impacting the quality of donor organs for transplantation. Extracellular vesicles (EVs) are cell-derived nanoparticles that carry functional biomolecules and reflect the physiological state of their cells of origin. We hypothesized that EVs from brain-dead donors may indicate lung injury and may be used to predict primary graft dysfunction (PGD) in lung transplant recipients.</p><p><strong>Methods: </strong>We performed transcriptomic profiling of plasma EVs from 44 brain-dead lung donors and 9 healthy controls using next-generation sequencing. Differential gene expression was assessed, followed by pathway enrichment analyses. The results were validated by qPCR using the study cohort and an independent cohort. VIP-score analysis and regression models were used to identify EV transcripts associated with PGD in recipients.</p><p><strong>Results: </strong>Transcriptomic analysis revealed that 13% of protein-coding genes were differentially expressed in lung donor EVs compared to controls, with 92% of these genes upregulated. Upregulated genes were enriched in pathways related to inflammation, coagulation, tissue remodelling, and metabolism. Seven key EV transcripts, RAD51D, ABL2, FGFR1, WDR82, PTBP3, OPRL1, and XG were identified as potential PGD indicator. These transcripts were associated with processes such as DNA damage repair, signal transduction, and inflammation, which may contribute to post-transplant lung injury.</p><p><strong>Conclusion: </strong>Donor plasma EVs carry distinct transcriptomic signatures associated with injury and inflammation. Specific EV transcripts, such as RAD51D and XG, hold promise as independent predictive biomarkers for PGD, possibly providing new tools for evaluating donor organ quality and improving lung transplant outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674717","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 hidden costs of reproductive legislation on surgical careers.","authors":"Nicole Lin, Busra Cangut, Stephanie Worrell","doi":"10.1016/j.jtcvs.2025.02.018","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.018","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674735","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 of thoracoabdominal aortic aneurysm repair in patients with and without peripheral arterial disease.","authors":"Alexis Nichols, Kyle W Blackburn, Veronica A Glover, Lynna H Nguyen, Ginger M Etheridge, Susan Y Green, Lauren K Barron, Anna H Xue, Subhasis Chatterjee, Vicente Orozco-Sevilla, Marc R Moon, Joseph S Coselli","doi":"10.1016/j.jtcvs.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.03.009","url":null,"abstract":"<p><strong>Objective: </strong>Certain comorbid atherosclerotic diseases have known associations with worse outcomes in thoracoabdominal aortic aneurysm (TAAA) repair; however, the association is less clear with peripheral arterial disease (PAD). This study investigates the relationship between PAD and TAAA repair outcomes.</p><p><strong>Methods: </strong>This retrospective, single-practice study analyzed data from 3772 patients who, from 1990-2023, underwent TAAA repair: 891 (23.6%) patients with PAD and 2881 (76.4%) patients without PAD. Outcomes included adverse event, which comprised operative death (before final hospital discharge or ≤30 days postoperatively) and key events persisting at discharge: stroke, spinal cord deficit (paraplegia or paraparesis), or renal failure necessitating dialysis.</p><p><strong>Results: </strong>Patients with PAD were older than patients without PAD (69 y [64-75] vs 66 y [56-73], P<.001). Patients with PAD had a lower rate of aortic dissection (21.1% vs 41.2%, P<.001). Patients with PAD more often underwent extent IV repair (30.4% vs 16.8%, P<.001), whereas patients without PAD more often had extent I repair (29.4% vs 16.9%, P<.001). Operative mortality did not differ between patients with and without PAD (9.2% vs 8.4%, P=.5). However, PAD patients had more spinal cord deficits (12.3% vs 9.1%, P=.004) and persistent stroke (3.6% vs 2.0%, P=.009); these differences were pronounced in extent II repair (18.6% vs 12.8% [P=.02] and 6.7% vs 3.0% [P=.005], respectively).</p><p><strong>Conclusions: </strong>Our data suggest that PAD is associated with higher rates of spinal cord deficit and persistent stroke after TAAA repair. This difference may necessitate the development of protective techniques for patients with PAD who undergo TAAA repair.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671668","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: Zenker per-oral endoscopic myotomy (Z-POEM): The ideal first-line therapy for treatment of Zenker diverticulum.","authors":"","doi":"10.1016/j.jtcvs.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.003","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634879","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: Rise of the machines-Normothermic regional perfusion use in heart transplantation in the United States.","authors":"","doi":"10.1016/j.jtcvs.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.007","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634866","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":"Mortality and Stroke after Routine Left Atrial Appendage Occlusion in Patients Undergoing Isolated Mitral Repair without Atrial Fibrillation in the United States.","authors":"Derrick Y Tam, Aminah Sallam, Qiudong Chen, George Gill, Armin Kiankhooy, Stephen E Fremes, Mario Gaudino, Richard Whitlock, Michael E Bowdish, Joanna Chikwe","doi":"10.1016/j.jtcvs.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.03.006","url":null,"abstract":"<p><strong>Background: </strong>The role of prophylactic concomitant left atrial appendage closure during mitral repair in patients without atrial fibrillation (AF) is not defined.</p><p><strong>Objectives: </strong>The objective was to compare long-term outcomes of patients who had left atrial appendage closure during mitral repair with those who did not in patients without AF.</p><p><strong>Methods: </strong>A large national registry was used to identify 38,597 patients undergoing isolated mitral repair from 2010 to 2019. After excluding prior cardiac surgery, endocarditis, emergencies, and AF history, we identified 10,810 isolated mitral repairs. Of these, 1,875(17%) received closure and 8,935(83%) did not. Propensity score matching was performed on 27 baseline characteristics. The primary outcome of any stroke or thromboembolism was compared between matched groups using the cumulative incidence function in a Fine-Gray model with death as a competing risk. All-cause mortality was compared in a Cox-proportional hazard model.</p><p><strong>Results: </strong>Propensity matching yielded 1,875 well-matched patient pairs (mean age:71 years, 45%female, median CHA2DS2-Vasc score 3.0). New post-operative AF was more common in the closure group (45%vs38.4%, p<0.01). There was no difference in 30-day mortality (1.2%vs1.1%, p=0.88). There was a reduction in stroke and thromboembolism over 5 years (6.4% vs 8.3%, HR: 0.74, 95%CI:0.57-0.96, p=0.023). There was no difference in 5-year survival (91% vs 91%, HR: 0.99, 95%CI:0.80-1.23, p=0.95).</p><p><strong>Conclusions: </strong>Left atrial appendage closure at the time of isolated mitral repair in patients without AF may be associated with increased incidence of post-operative AF, but reduced late stroke and thromboembolism compared to mitral repair alone.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639794","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":"Unplanned reinterventions after congenital cardiac surgery and hospital mortality: a report from the Pediatric Cardiac Critical Care Consortium (PC⁴).","authors":"Reshma K Reddy, Kurt R Schumacher, Nancy S Ghanayem, Wenying Zhang, Katherine Mikesell, Jeffrey A Alten, David K Bailly, Rebecca A Bertrandt, Joshua J Blinder, Jason R Buckley, Titus Chan, Nikhil K Chanani, Aaron G DeWitt, J Wesley Diddle, Jennifer Gauntt, William G Harmon, Jeffrey P Jacobs, Robert B Kelly, Jiuann-Huey I Lin, Richard P Lion, Tia T Raymond, Christine M Riley, Steven M Schwartz, Andrew Y Shin, Janet M Simsic, Anjuli Sinha, Andrew H Smith, Sarah Tabbutt, David K Werho, Hayden J Zaccagni, John M Costello","doi":"10.1016/j.jtcvs.2025.03.005","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.03.005","url":null,"abstract":"<p><strong>Objectives: </strong>Unplanned cardiac reinterventions (UCR) after congenital cardiac surgery may complicate the post-operative course. We sought to identify incidence rates and risk factors for UCRs and associations between UCRs and hospital mortality.</p><p><strong>Methods: </strong>Patients in the Pediatric Cardiac Critical Care Consortium (PC⁴) registry undergoing an index cardiac operation from February 2019 to January 2022 were included. Multivariable logistic regression, adjusted for center effect, was used to evaluate patient risk factors for UCR and the impact of reintervention on hospital mortality.</p><p><strong>Results: </strong>Included were 34,495 patients from 62 centers. UCRs occurred in 2,635 (7.6%) patients with wide center variation. Risk factors for UCR included Black race, extracardiac and chromosomal anomalies, younger age, lower weight for age, prior cardiac surgeries, and higher surgical complexity category. The performance of an UCR was associated with higher hospital mortality (16.1%) compared to those who did not undergo reintervention (1.3%) (aOR, 6.45; 95% CI, 5.51-7.56, P<0.001). The odds of mortality after UCR increased with higher STAT-EACTS category. Mortality was highest in patients who underwent both reoperation and interventional catheterization (31.9%) compared to those who only underwent reoperation (16.3%) or catheterization (9.8%).</p><p><strong>Conclusions: </strong>UCRs occur in approximately one in 13 patients after congenital cardiac surgery, and approximately one in six patients with an UCR will die. Patients at greatest risk for UCR may share patient and disease-specific risk factors. Further investigation is needed to minimize the incidence of residual lesions, understand why Black children have more UCRs, and explore modifiable risk factors for and optimal timing of UCRs.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639807","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":"Association of Chemoradiation, Trimodality Therapy, or Salvage Resection with Survival in Stage II-III Esophageal Squamous Cell Carcinoma.","authors":"Sara Sakowitz, Syed Shahyan Bakhtiyar, Saad Mallick, Yas Sanaiha, Ann Raldow, Peyman Benharash, Jane Yanagawa","doi":"10.1016/j.jtcvs.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.03.004","url":null,"abstract":"<p><strong>Objective: </strong>Esophageal squamous cell carcinoma(ESCC) remains highly lethal and often under-treated. With conflicting evidence regarding the additional benefit of surgical resection to chemoradiation, many patients with locoregionally-advanced disease may receive chemoradiation and then undergo evaluation for progression before esophagectomy. We hypothesized that trimodality therapy or salvage resection would be linked with superior overall survival, relative to definitive chemoradiation.</p><p><strong>Methods: </strong>This retrospective analysis of the 2004-2021 National Cancer Database identified all clinically-staged II-III ESCC patients≥18years. Patients undergoing chemotherapy and ≥41.4 Grays of radiation across 28 fractions, followed by esophagectomy <90 days were considered the trimodality cohort, while those undergoing resection ≥90 days were classified as salvage. Patients receiving definitive chemoradiation were categorized as definitive CRT.</p><p><strong>Results: </strong>Of 3,786 patients, 912 (24%) underwent trimodality therapy, 173 (5%) chemoradiation followed by salvage resection, and 2,701 (71%) definitive CRT. Following risk-adjustment and relative to definitive CRT, trimodality was linked with greater survival at 1 (HR 0.45, CI 0.34-0.59) and 5 years (HR 0.57, CI 0.49-0.66), as was salvage (1 year: HR 0.38, CI 0.22-0.69; 5 year: HR 0.54, CI 0.40-0.73). Upon RMST analysis, trimodality demonstrated a 9.17 month (CI 6.40-11.94) incremental increase in overall survival time over 5 years, while salvage was linked with a 10.03 month (CI 4.04-16.03) increase in survival time, compared to definitive CRT.</p><p><strong>Conclusions: </strong>Surgical resection following chemoradiation confers survival benefit and should be considered a mainstay in the management of locoregionally-advanced ESCC. Yet, with comparable outcomes across trimodality and salvage approaches, organ preservation may be appropriate, for select patients.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639791","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":"Moving toward better outcomes: Time to be active before lung cancer surgery.","authors":"Jordan Curry, Cecilia Pompili","doi":"10.1016/j.jtcvs.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.010","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606876","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":"Survival trends of adults with congenital heart disease after heart surgery in Sweden.","authors":"Sanin Fazlinovic, Hans Lidén, Vibeke Hjortdal, Kok Wai Giang, Mikael Dellborg, Zacharias Mandalenakis, Carl Johan Malm","doi":"10.1016/j.jtcvs.2025.02.030","DOIUrl":"10.1016/j.jtcvs.2025.02.030","url":null,"abstract":"<p><strong>Objective: </strong>Congenital heart disease is the most common congenital anomaly. This study evaluated long-term mortality in patients who underwent childhood heart surgery and survived to adulthood.</p><p><strong>Methods: </strong>Using Swedish national registries, we identified 24,774 adults with congenital heart disease born between 1970 and 1999 who were alive at 18 years. Of these, a total of 7585 underwent childhood heart surgery and were matched with 54,540 controls by birth year and sex. Follow-up began at age 18 years and extended until death or study end (2017). Survival was assessed using Kaplan-Meier estimates and Cox proportional hazards models.</p><p><strong>Results: </strong>Over a mean follow-up of 12.7 years, 227 patients (3.0%) died, with a hazard ratio of 5.02 (95% CI, 4.23-5.95, P < .001). Complex lesions had a higher hazard ratio of 7.03 (95% CI, 5.45-9.06, P < .001), peaking at 8.27 (95% CI, 6.13-11.16, P < .001) for conotruncal defects. In noncomplex lesions, ventricular septal defects had a hazard ratio of 5.03 (95% CI, 3.20-7.92, P < .001). Mortality risk was highest for those born in the 1970s, standing at 5.95 (95% CI, 4.67-7.58, P < .001), with improving survival in subsequent decades.</p><p><strong>Conclusions: </strong>Patients with congenital heart disease surviving childhood heart surgery had a 5-fold higher mortality risk compared with controls, particularly the complex lesion groups. Even though being noncomplex, ventricular septal defects showed a 5-fold higher mortality risk than controls. These patients were repaired but not cured and in need of lifelong follow-up. However, survival has significantly improved for those born in the 1990s, now comparable to matched controls up to 10 years.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587863","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}