Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Twenty-five years of the ross operation in adults: The inclusion technique keeps up the expectations","authors":"Federica Caldaroni MD ,&nbsp;Peter Skillington MD, FRACS ,&nbsp;Michael O'Keefe MD ,&nbsp;Edward Buratto MD, PhD ,&nbsp;Rochelle Wynne PhD","doi":"10.1016/j.jtcvs.2025.01.007","DOIUrl":"10.1016/j.jtcvs.2025.01.007","url":null,"abstract":"<div><h3>Background</h3><div><span>In adults, the Ross procedure<span> provides an excellent alternative to prosthetic valves, but it is underutilized because of concerns about technical complexity, durability, and perceived high late </span></span>reoperation<span> rates. The inclusion technique stabilizes the aortic root, prevents dilatation, and respects the dynamic root physiology. Long-term outcomes of the Ross procedure with the inclusion cylinder technique (1992-2022) are reported.</span></div></div><div><h3>Methods</h3><div>Long-term (12.2 years; 95% CI, 11.5-12.8) single institution results, with more than 25 years of follow-up in 44 patients. A total of 516 patients aged 39 ± 13 years underwent Ross procedure with inclusion cylinder and annular reduction. All had yearly clinical review and biannual transthoracic echocardiogram<span><span><span>. The etiology of valve disease comprised aortic stenosis (AS) (n = 233 [44.8%]), </span>aortic regurgitation (AR) (n = 179 [34.4%]), and mixed AS/AR (n = 108 [20.8%]). The primary end points were 25-year survival and freedom from reoperation, with degree of </span>autograft regurgitation in all morphologies (AS, AR, and mixed AR/AS) as the secondary end point.</span></div></div><div><h3>Results</h3><div><span>Total reoperation rate was 8.3% after 25 years (n = 43; aortic valve<span> = 28, pulmonary valve 15), with early reoperation (&lt;1 year) in 0.6% and early postoperative death in 0.2% following myocardial infarction. Overall, 25-year survival was 85.3%, and 25-year freedom from autograft reoperation was 89.5% (AS = 95.0%, AR = 78.0%, and mixed AS/AR = 94.3%) (</span></span><em>P</em><span> = .01). Freedom from redo pulmonary valve replacement was 92.7%.</span></div></div><div><h3>Conclusions</h3><div>The Ross procedure with inclusion cylinder technique provides excellent hemodynamics. Autograft inclusion in the native aorta minimizes prosthetic material and respects physiological root changes, reducing shear stress on neoaortic cusps and increasing durability. Long-term reoperation rate is low in experienced centers.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1017-1024.e1"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015238","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":"Midterm survival, clinical, and hemodynamic outcomes of a novel mechanical mitral valve prosthesis","authors":"Marc Ruel MD, MPH ,&nbsp;Michael W.A. Chu MD, Med ,&nbsp;Allen Graeve MD ,&nbsp;Marc W. Gerdisch MD ,&nbsp;Ralph J. Damiano Jr. MD ,&nbsp;Robert L. Smith II MD ,&nbsp;William Brent Keeling MD ,&nbsp;Michael A. Wait MD ,&nbsp;Robert C. Hagberg MD ,&nbsp;Reed D. Quinn MD ,&nbsp;Gulshan K. Sethi MD ,&nbsp;Rosario Floridia MD ,&nbsp;Christopher J. Barreiro MD ,&nbsp;Andrew L. Pruitt MD ,&nbsp;Kevin D. Accola MD ,&nbsp;Francois Dagenais MD ,&nbsp;Alan H. Markowitz MD ,&nbsp;Jian Ye MD ,&nbsp;Michael E. Sekela MD ,&nbsp;Ryan Y. Tsuda MD ,&nbsp;John D. Puskas MD","doi":"10.1016/j.jtcvs.2024.11.029","DOIUrl":"10.1016/j.jtcvs.2024.11.029","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the midterm survival, clinical, and hemodynamic outcomes of the On-X mechanical mitral valve, based on the 5-year results of the Prospective Randomized On-X Anticoagulation Clinical Trial (PROACT).</div></div><div><h3>Method</h3><div>PROACT Mitral was a multicenter study evaluating 401 patients who underwent mitral valve replacement (MVR) with either Standard or Conform-X On-X mitral valves, comparing low-dose and standard-dose warfarin. Here we report prespecified secondary outcomes of survival, New York Heart Association (NYHA) functional classification, and valve hemodynamics as assessed by core lab–adjudicated echocardiography at 1, 3, and 5 years in the pooled population.</div></div><div><h3>Results</h3><div>Actuarial survival was 99.7% at 1 year, 95.1% at 3 years, and 92.4% at 5 years, with no significant difference between the Standard and Conform-X cuffs. Hemodynamic analysis revealed a mean transvalvular pressure gradient (MG) of 4.6 ± 2.0 mm Hg at 1 year, with no interaction between valve size and patient body surface area. MG values were consistent over time. Quality of life improved with 96.6% of patients in NYHA class I or II at the latest available follow-up of 3 or 5 years. There were no significant differences in survival, clinical, or hemodynamic outcomes between valve sizes.</div></div><div><h3>Conclusions</h3><div>The On-X mechanical mitral valve demonstrated favorable survival, stable hemodynamics, and enhanced quality of life up to 5 years postimplantation. Derived from high-quality, rigorous randomized trial data, these findings can guide decision making in young patients requiring MVR.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1060-1068.e3"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774256","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: Interpreting postoperative survival trends in adults with congenital heart disease from a registry-based perspective","authors":"Sanin Fazlinovic MD ,&nbsp;Mikael Dellborg MD, PhD ,&nbsp;Zacharias Mandalenakis MD, PhD ,&nbsp;Carl Johan Malm MD, PhD","doi":"10.1016/j.jtcvs.2025.04.023","DOIUrl":"10.1016/j.jtcvs.2025.04.023","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages e106-e107"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047731","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":"Initial experience with fully robotic bilateral lung transplantation","authors":"Stephanie H. Chang MD, MSCI ,&nbsp;Eugene A. Grossi MD ,&nbsp;Camille Yongue MD ,&nbsp;Justin C.Y. Chan MD ,&nbsp;Luis F. Angel MD ,&nbsp;Travis C. Geraci MD","doi":"10.1016/j.jtcvs.2025.04.011","DOIUrl":"10.1016/j.jtcvs.2025.04.011","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages e87-e91"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005180","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":"Adult Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(25)00729-9","DOIUrl":"10.1016/S0022-5223(25)00729-9","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages e93-e94"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189715","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":"Valve-sparing aortic root replacement in bicuspid aortic valves—the reimplantation technique: A multicenter study","authors":"Bardia Arabkhani MD, PhD ,&nbsp;Munir Boodhwani MD, PhD ,&nbsp;Ruggero De Paulis MD, PhD ,&nbsp;Edward P. Chen MD, PhD ,&nbsp;Dave Koolbergen MD, PhD ,&nbsp;Stefano Mastrobuoni MD ,&nbsp;Gaby Aphram MD ,&nbsp;Andrea Salica MD ,&nbsp;Jama Jahanyar MD, PhD ,&nbsp;Gebrine el Khoury MD, PhD ,&nbsp;Laurent de Kerchove MD, PhD","doi":"10.1016/j.jtcvs.2025.02.008","DOIUrl":"10.1016/j.jtcvs.2025.02.008","url":null,"abstract":"<div><h3>Objective</h3><div>Reported outcomes in patients with bicuspid aortic valves (BAVs) undergoing valve-sparing aortic root replacement (VSRR) are scarce. This study aims to evaluate outcomes in patients with BAV using the reimplantation (David) technique.</div></div><div><h3>Methods</h3><div>Consecutive adult patients with BAV, aortic root aneurysm, and/or aortic valve insufficiency (AI) undergoing VSRR (reimplantation) were included from 5 centers experienced in reimplantation procedures. Patients were subcategorized into 2 groups with different primary indications for operation: (1) aneurysm, and (2) isolated AI. Exclusion criteria included acute aortic dissection, endocarditis, and valvular-stenosis.</div></div><div><h3>Results</h3><div>In total, 498 patients were included. Mean age was 45.4 years (±11.8 years); median follow-up was 5.4 years (interquartile range, 2.3-8.7 years). Group 1 included aneurysm (n = 144) and group 2 included AI (n = 354). There was 1 in-hospital death. Survival (overall) was 93.4% (95% confidence interval [CI], 92-97%) at 10 years, with no difference between groups (<em>P</em> = .93) observed. Freedom from reintervention at 1 year was 99.1% (95% CI, 99%-100%), at 5 years 95.4% (95% CI, 93%-97%), and at 10 years 89.2% (95% CI, 86%-93%) for patients with aneurysm 100% at 1 year and 95.4% (95% CI, 92%-98%) at 10 years; and for AI 98.9% (95% CI, 98%-99%) at 1 year and 86.4% (95% CI, 83%-91%) at 10 years. Cusp fenestrations (<em>P</em> = .01), prolapse (<em>P</em> = .04), and isolated AI (0.03) were associated with greater hazard of reintervention.</div></div><div><h3>Conclusions</h3><div>This multicenter study shows excellent results after VSRR reimplantation procedure in patients with BAV and aortic aneurysm and/or valve insufficiency. Isolated AI and cusp abnormalities are associated with greater reintervention rates and may reflect more advanced leaflet disease. The reimplantation technique, when performed in expert centers, appears to be an excellent treatment strategy in BAV.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1025-1034"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460455","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":"Review of the decision making approach to treating young and low-risk patients with aortic stenosis","authors":"Tanush Gupta MD ,&nbsp;S. Chris Malaisrie MD ,&nbsp;Wayne Batchelor MD ,&nbsp;Konstantinos Dean Boudoulas MD ,&nbsp;Laura Davidson MD ,&nbsp;Uzoma N. Ibebuogu MD ,&nbsp;Jacques Kpodonu MD ,&nbsp;Ramesh Singh MD ,&nbsp;Ibrahim Sultan MD ,&nbsp;Misty Theriot BSN ,&nbsp;Michael J. Reardon MD ,&nbsp;Martin B. Leon MD ,&nbsp;Kendra J. Grubb MD, MHA ,&nbsp;A Perspective from the American College of Cardiology Cardiac Surgery Team and Interventional Cardiology Councils","doi":"10.1016/j.jtcvs.2024.12.027","DOIUrl":"10.1016/j.jtcvs.2024.12.027","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1035-1040"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973022","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":"Development of and recovery from acute kidney injury after cardiac surgery: Randomized phase 2 trial of the hepatocyte growth factor mimetic ANG-3777","authors":"Sabry S. Ayad MD ,&nbsp;Thomas Beaver MD ,&nbsp;David Corteville MD ,&nbsp;Madhav Swaminathan MD ,&nbsp;Ronald G. Pearl MD ,&nbsp;Shakil Aslam MD ,&nbsp;Philipp Andreas Csomor PhD ,&nbsp;Gabriela Alperovich MD ,&nbsp;John Neylan MD","doi":"10.1016/j.jtcvs.2024.11.024","DOIUrl":"10.1016/j.jtcvs.2024.11.024","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate the safety and efficacy of ANG-3777, a hepatocyte growth factor mimetic, in mitigating the risk of acute kidney injury (AKI) in patients undergoing cardiac surgery with cardiopulmonary bypass.</div></div><div><h3>Methods</h3><div>In this double-blind placebo-controlled study (Guard Against Renal Damage [GUARD]), patients were randomized to receive intravenous ANG-3777 2 mg/kg or placebo once daily for 4 days. The primary end point was severity of AKI, measured by mean area under the concentration-time curve on percent increase in serum creatinine from days 2 to 6. Secondary end points included the proportions of patients who developed major adverse kidney events by day 30 or 90 and the percentage of patients diagnosed with AKI through day 5.</div></div><div><h3>Results</h3><div>In total, 259 patients received study treatment (ANG-3777, n = 129; placebo, n = 130). Through day 6, there was no significant difference in least-squares mean change in serum creatinine between ANG-3777 and placebo (1.1%; 95% confidence interval, −6.2 to 8.4; <em>P</em> = .77), or in proportions of patients who developed major adverse kidney events by day 30 (18.6% vs 16.2%; <em>P</em> = .60) or day 90 (14.7% vs 21.5%; <em>P</em> = .16). Similar proportions of patients were diagnosed with AKI through day 5 (ANG-3777, 47.3%; placebo, 48.5%); however, exploratory analysis revealed more patients diagnosed with AKI postoperatively showed signs of recovery after treatment with ANG-3777 than placebo. Overall, ANG-3777 was well tolerated, with similar incidences of treatment-emergent adverse events between treatment arms.</div></div><div><h3>Conclusions</h3><div>Findings from this study do not support the efficacy of ANG-3777 in preventing the development of AKI after cardiopulmonary bypass.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1125-1132.e2"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741137","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":"Thoracic Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(25)00726-3","DOIUrl":"10.1016/S0022-5223(25)00726-3","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Page e83"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189713","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 performance of a new nanosecond pulsed-field ablation surgical clamp in the ablation of cardiac tissue: A chronic porcine model","authors":"Gansevoort H. Dunnington MD ,&nbsp;Stephen D. Waterford MD, MS ,&nbsp;Darrin Uecker MS ,&nbsp;Lauren Johnston BS ,&nbsp;David Danitz MS ,&nbsp;Anita Crompton BS, MS ,&nbsp;Niv Ad MD","doi":"10.1016/j.jtcvs.2024.11.036","DOIUrl":"10.1016/j.jtcvs.2024.11.036","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this chronic porcine model is to demonstrate the safety and efficacy of a new nanosecond pulsed-field ablation (nsPFA) parallel clamp in ablating different cardiac tissue.</div></div><div><h3>Methods</h3><div>The Pulse Biosciences nsPFA CellFX Clamp System was tested on 6 pigs. Ablations were performed in all 4 heart chambers by delivering a sequence of very short-duration, high-amplitude electrical pulses taking 1.25 seconds per application independent of tissue thickness or type. Testing for electrical exit block was performed at the time of surgery and at study termination. At 35 days, animals were killed humanely and anonymized histopathology was performed to assess lesion width, depth, and transmurality. Lesion pattern and general safety were compared with 6 animals in which a bipolar radiofrequency clamp was used (AtriCure Synergy Isolator System).</div></div><div><h3>Results</h3><div>There were no device-related serious adverse events in the nsPFA group. There was 1 early device-related mortality at day 24 in the RFA group from perforation of 1 of the ventricular ablation sites. There were also 2 intracardiac thrombotic events with 1 systemic thromboembolic event in the radiofrequency group. Exit block was confirmed in all animals from both groups for the pulmonary veins and the posterior wall. Histologic findings were consistent and demonstrated mature scar formation in all nsPFA ablation specimens, whereas a 7.1% rate of incomplete histopathological scar maturation was present in the RFA group.</div></div><div><h3>Conclusions</h3><div>In this chronic porcine model, a single 1.25-second application independent of tissue thickness with the CellFX Parallel Clamp System demonstrated promising safety and efficacy profile. All lesions produced by this technology resulted in persistent exit block around pulmonary veins and the posterior atrial wall consistent with a reliable, contiguous and transmural ablation without injury to adjacent organs.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1069-1078"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792698","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}