Journal of Thoracic and Cardiovascular Surgery最新文献

{"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}

{"title":"Extra-cardiac conduit restriction is associated with increased liver fibrosis in adolescent Fontan patients.","authors":"Matteo Ponzoni, Jamal Saleh, Rajiv R Chaturvedi, Anne I Dipchand, Israel Valverde, Mike Seed, Shi-Joon Yoo, John Coles, Osami Honjo, Christopher Z Lam","doi":"10.1016/j.jtcvs.2025.09.044","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.044","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the association between extra-cardiac conduit (ECC) restriction, as assessed by magnetic resonance imaging (MRI), and Fontan hemodynamics, exercise capacity, laboratory tests, and liver fibrosis in adolescent Fontan patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 93 Fontan patients who underwent fasting heart-liver MRIs between 2018 and 2022. ECC minimal diameter and cross-sectional area (CSA) were measured, and liver fibrosis was graded on delayed gadolinium enhancement sequences. Correlations between MRI and clinical/functional/laboratory data were explored using Spearman's correlation and Mann-Whitney test. Multivariable regression was performed to assess the effect of ECC size on liver fibrosis development.</p><p><strong>Results: </strong>After a median of 10.2 (interquartile range, 8.1-12.7) years post-Fontan, ECC diameter had a median reduction of 27.3 (22.7-31.8)% from its original size. Minimal ECC diameter correlated with peak oxygen consumption (VO2) (ρ=0.324, p=0.004) and VO2 at anaerobic threshold (ρ=0.372, p=0.002). Patients with PLE exhibited smaller ECC diameters (14.0 (13.0-15.5) mm vs.16.0 (14.0-17.0) mm; p=0.020), compared to those without PLE. Patients with >mild liver fibrosis had smaller ECC diameters (14.0 (13.8-15.3) mm vs. 16.0 (15.0-17.0) mm, p<0.001), compared to those with none-mild fibrosis. At multivariable regression analysis, 1-mm increase in ECC minimal diameter decreased the risk of >mild liver fibrosis by 54.3% (odds-ratio=0.457, 95% confidence-interval: 0.264-0.791, p=0.005).</p><p><strong>Conclusions: </strong>ECC restriction is associated with increased liver fibrosis, PLE, and reduced exercise tolerance in adolescent Fontan patients. These findings suggest that conduit upsizing strategies may be considered to alleviate hepatic congestion and improve functional capacity.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234014","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: Selecting patients and tailoring surgical extent in stage IV non - small cell lung cancer.","authors":"Raphael Werner, Mara B Antonoff","doi":"10.1016/j.jtcvs.2025.09.001","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.001","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226344","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":"Rwanda as a model for integrated surgical care of women of reproductive age with rheumatic heart disease.","authors":"Valdano Manuel, Adriana Bernardo, Joaquim Gouveia","doi":"10.1016/j.jtcvs.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.007","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214321","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":"Propofol-supplemented cardioplegia: a multi-center blinded three-group randomized trial (ProMPT2).","authors":"Gianni D Angelini, Helena J M Smartt, Katherine Joyce, Rachael Heys, Rachel Maishman, Lucy Culliford, Samantha E de Jesus, Beth M Fitzgerald, M Saadeh Suleiman, Prakash Punjabi, Nnamdi Nwaejike, Richard Downes, Ben Gibbison, Chris A Rogers","doi":"10.1016/j.jtcvs.2025.09.040","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.040","url":null,"abstract":"<p><strong>Objective: </strong>Coronary artery bypass grafting using cardiopulmonary bypass and cardioplegic arrest is an effective treatment for coronary artery disease. Research suggests supplementing the cardioplegia solution with propofol may be cardioprotective. The aim was to compare the safety and efficacy of supplementing the cardioplegia solution with different doses of propofol in adults undergoing first-time surgery.</p><p><strong>Methods: </strong>A blinded, parallel group randomized controlled trial conducted in 3 hospitals in the UK comparing a cardioplegia solution supplemented with high-dose propofol (concentration 12mcg/mL), low-dose propofol (concentration 6mcg/mL) or placebo (saline). Primary outcome was cardiac troponin T measurements over the first 48 hours after surgery. Participants were followed-up for 12 months.</p><p><strong>Results: </strong>240 participants, median age 66 years, 90% male, were randomly allocated; 78 to high-dose propofol, 80 to low-dose propofol and 82 to placebo. 239 participants were included in the primary analysis. Geometric mean cardiac troponin release at 48 hours (95% confidence interval) was 145ng/L (125-168), 162ng/L (138-191) and 150ng/L (125-180) in the high-dose propofol, low-dose propofol and placebo groups respectively (adjusted geometric mean ratio 1.06; 95% confidence interval 0.97-1.15; P=0.20, for pairwise comparisons between high and low-dose propofol and between low-dose propofol and placebo). 96 adverse events which prolonged the hospital stay, or were life-threatening were reported (33, 26 and 37 in the high-dose propofol, low-dose propofol and placebo groups respectively) and four deaths (1 low-dose propofol group, 3 placebo group).</p><p><strong>Conclusions: </strong>Propofol supplementation of warm blood cardioplegia at both the lower and higher concentrations is safe but there is no evidence to suggest either dose is cardioprotective.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228658","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}