Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Effects of Mitral Calcification in Severe Aortic Stenosis with Severe Mitral Regurgitation on Left Heart Remodeling, Surgical Strategy, and Outcomes.","authors":"Abigail Snyder, Monica Isabella, Leonardo Rodriguez, Paul Bishop, Nicholas G Smedira, Jeevanantham Rajeswaran, Benjamin P Kramer, Ashley M Lowry, Eugene H Blackstone, Eric E Roselli","doi":"10.1016/j.jtcvs.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.022","url":null,"abstract":"<p><strong>Objectives: </strong>To localize and quantify mitral calcification associated with severe aortic stenosis and severe mitral regurgitation and determine its association with cardiac remodeling, operative management, and long-term survival.</p><p><strong>Methods: </strong>From July 1998 to July 2010, 158 patients with severe aortic stenosis, severe mitral regurgitation, and mitral calcification underwent surgical aortic valve replacement (SAVR, n=49) or SAVR plus mitral valve repair (SAVR+MVr, n=67) or replacement (SAVR+MVR, n=42). Mitral calcium was localized and quantified on preoperative computed tomography. Random forest methodology was used to correlate calcium volume with cardiac morphology and function. Median follow-up for survival was 4.1 years; 25% were followed ≥14 years.</p><p><strong>Results: </strong>Larger calcium volume was associated with degenerative mitral disease, higher ejection fraction, smaller left ventricular end-systolic volume, and SAVR+MVR (median calcium volume 3.4 cm³) versus SAVR (median calcium volume 1.0 cm³) or SAVR+MVr (median calcium volume 0.41 cm³). Ten-year mortality was higher in patients with more mitral calcification (terciles: 7.1% vs 16% vs 25%), subvalvular involvement (8.1% vs 18%), and SAVR+MVR (5.4% vs SAVR=13% vs SAVR+MVr=26%). Multivariable analysis demonstrated early postoperative mortality was strongly associated with subvalvular mitral calcification, but late mortality was not associated with calcium volume or location.</p><p><strong>Conclusions: </strong>Larger mitral calcium volume is a marker of late-stage cardiac remodeling associated with more extensive mitral valve intervention, but it is not associated with long-term mortality. Quantitative analysis of mitral calcification with computed tomography can aid in patient selection and surgical management decisions in this complex patient population.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512042","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 anatomy of aortic root: towards precise and durable aortic, neo-aortic and truncal valve repairs.","authors":"Hans-Joachim Schäfers, Igor E Konstantinov","doi":"10.1016/j.jtcvs.2024.10.010","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.010","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512043","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":"Durability of Right Ventricular Conduits in the Ross Procedure.","authors":"Karen B Abeln, Lennart Froede, Christian Giebels, Hans-Joachim Schäfers","doi":"10.1016/j.jtcvs.2024.10.023","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.023","url":null,"abstract":"<p><strong>Objectives: </strong>Right ventricular (RV) conduit availability and degeneration are potential limitations of the Ross procedure. Pulmonary homografts are the gold standard but their limited availability drives the need for alternatives. The aim of this study was to compare results of different RV conduits.</p><p><strong>Methods: </strong>Between 1995 and 2023, 315 consecutive patients (mean age:37±12years, 73% male) underwent a Ross procedure using a homograft (n=211), bovine jugular vein ('BJV') (n=34) or xenograft (n=70) as RV conduit. Mean follow-up was 5.7±6.7years and was 96% complete (1631 patient-years).</p><p><strong>Results: </strong>Twelve patients (homograft 8/211, BJV 3/34, xenograft 1/70) required RV conduit reintervention, four patients (homograft) within 4 years. Indications for reintervention were degeneration (n=8) and active endocarditis (n=4). Reinterventions included RV conduit replacement (n=6, homograft n=3, xenograft n=1, BJV n=2) and transcatheter valve implantation (n=6, homograft n=5, BJV n=1). At 15years, freedom from RV conduit reintervention was 88%; freedom from reoperation was 93%. Freedom from reintervention at 15years was similar between homografts (89%), BJV (89%), and xenografts (100%)(p=0.812). Progression of mean RV conduit gradient was lowest for the BJV (1.45mmHg/year) and similar between the homograft (2.6mmHg/year) and xenograft (2.9mmHg/year). Age at surgery (<18years; p<0.001; HR 1.9) was a predictive risk factor for reintervention. There was no difference between RV conduits (p=0.606; HR 1.198).</p><p><strong>Conclusions: </strong>The incidence of reintervention after 15years is similar between homografts, xenograft, and BJV. Interestingly, homografts may fail in the first few years, possibly related to inflammatory phenomena. Thus, the use of xenografts may be an option if homografts are not available.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512041","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: Chest wall resection for sarcoma: Evolution in Thoracic Park.","authors":"Samine Ravanbakhsh, Jonathan D'Cunha","doi":"10.1016/j.jtcvs.2024.10.019","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.019","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479276","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: Chronic total occlusions and coronary artery bypass grafting outcomes.","authors":"","doi":"10.1016/j.jtcvs.2024.09.007","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.007","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479282","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: Heroic Hearts Made Weak by Time and Fate.","authors":"Ashish S Shah","doi":"10.1016/j.jtcvs.2024.10.020","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.020","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479278","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: Once again, we should only do good Fontans! Plastic bronchitis is not due to bad luck.","authors":"Alyssia Venna, Yves d'Udekem","doi":"10.1016/j.jtcvs.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.021","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479280","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":"Multiarterial Grafting in Redo CABG: Type of Arterial Conduit and Patient Sex Determine Benefit.","authors":"Gabriele M Iacona, Jules J Bakhos, Penny L Houghtaling, Aaron E Tipton, Richard Ramsingh, Nicholas G Smedira, Marc Gillinov, Kenneth R McCurry, Edward G Soltesz, Eric E Roselli, Michael Z Tong, Shinya G Unai, Haytham J Elgharably, Marijan J Koprivanac, Lars G Svensson, Eugene H Blackstone, Faisal G Bakaeen","doi":"10.1016/j.jtcvs.2024.10.018","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.018","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether multiarterial grafting provides incremental benefit above single arterial grafting in isolated redo CABG.</p><p><strong>Methods: </strong>From 1/1980 to 7/2020, 6559 adults underwent 6693 isolated CABG reoperations. Patients undergoing multiarterial grafting were propensity-score matched with those undergoing single arterial grafting, with or without additional vein grafts, yielding 2005 well-matched pairs. Endpoints were in-hospital postoperative complications, hospital mortality, and long-term mortality. Median follow-up was 10 years with 25% followed >17 years. Multivariable multiphase hazard modeling and nonparametric random survival forests for survival were used to identify patients for whom multiarterial grafting was most beneficial.</p><p><strong>Results: </strong>Among propensity-matched patients, postoperative complications for multiarterial versus single arterial grafting were any reoperation, 50 (2.5%) versus 65 (3.2%); renal failure, 73 (3.6%) versus 55 (2.7%); stroke, 44 (2.2%) versus 38 (1.9%); and deep sternal infection, 36 (1.8%) versus 25 (1.2%). Hospital mortality was 1.7% (n=35) versus 2.8% (n=56) (P=.03). Comparing multiarterial to single arterial grafting, survival at 1 and 3 years was 95% versus 94% and 92% versus 88%, and at 5, 15, and 20 years, survival was 87%, 49%, and 31% versus 82%, 42%, and 25%. Better survival after multiarterial grafting was confined to males with 2 patent internal thoracic artery grafts (P<.0001).</p><p><strong>Conclusions: </strong>Redo CABG with multiarterial grafting can be performed with lower in-hospital mortality and similar major morbidity to single arterial grafting. It is associated with better long-term survival, particularly in males when 2 internal thoracic artery grafts are used.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479292","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: Ask Yourself Always: How Can This Be Done Better?","authors":"Katherine E Sprouse, William L Holman","doi":"10.1016/j.jtcvs.2024.10.015","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.015","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479275","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: Getting to the root of the matter when managing the trunk.","authors":"L Mac Felmly, Minoo N Kavarana","doi":"10.1016/j.jtcvs.2024.10.017","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.017","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479277","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}