Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Ask why not: The case for on-table extubation in cardiac surgery.","authors":"Russell Pepe, John Tobia, Leonard Y Lee","doi":"10.1016/j.jtcvs.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.014","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674711","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 preoperative diabetes assessment: Implications for acute myocardial infarction-coronary artery bypass grafting management and long-term outcomes.","authors":"Mengxia Qi, Xiangying Yang","doi":"10.1016/j.jtcvs.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.017","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674726","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: Occluded fenestration is linked to increased oxygen saturation, reduced N-terminal pro-B-type natriuretic peptide, and improved survival rates.","authors":"Hīng-Ka Lîm, Shuenn-Nan Chiu","doi":"10.1016/j.jtcvs.2025.02.019","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.02.019","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674732","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":"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":"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 underwent TAAA repair between 1990 and 2023, including 891 patients (23.6%) with PAD and 2881 (76.4%) without PAD. Outcomes included adverse events, which comprised operative death (before final hospital discharge or ≤30 days postoperatively) and key events persisting at discharge: stroke, spinal cord deficit (SCD; paraplegia or paraparesis), or renal failure necessitating dialysis.</p><p><strong>Results: </strong>Patients with PAD were older than patients without PAD (median, 69 years [interquartile range (IQR), 64-75 years] versus 66 years [IQR, 56-73 years]; 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 PAD and those without PAD (9.2% vs 8.4%; P = .5). However, PAD patients had more SCD (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 SCD 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":"10.1016/j.jtcvs.2025.03.005","url":null,"abstract":"<p><strong>Objectives: </strong>Unplanned cardiac reinterventions after congenital cardiac surgery may complicate the postoperative course. We sought to identify incidence rates and risk factors for unplanned cardiac reinterventions and associations between unplanned cardiac reinterventions and hospital mortality.</p><p><strong>Methods: </strong>Patients in the Pediatric Cardiac Critical Care Consortium 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 unplanned cardiac reinterventions and the impact of reintervention on hospital mortality.</p><p><strong>Results: </strong>Included were 34,495 patients from 62 centers. Unplanned cardiac reinterventions occurred in 2635 patients (7.6%) with wide center variation. Risk factors for unplanned cardiac reinterventions 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 unplanned cardiac reintervention was associated with higher hospital mortality (16.1%) compared with those who did not undergo reintervention (1.3%) (adjusted odds ratio, 6.45; 95% CI, 5.51-7.56, P < .001). The odds of mortality after unplanned cardiac reinterventions increased with higher Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery category. Mortality was highest in patients who underwent both reoperation and interventional catheterization (31.9%) compared with those who underwent only reoperation (16.3%) or catheterization (9.8%).</p><p><strong>Conclusions: </strong>Unplanned cardiac reinterventions occur in approximately 1 in 13 patients after congenital cardiac surgery, and approximately 1 in 6 patients with an unplanned cardiac reintervention will die. Patients at greatest risk for unplanned cardiac reinterventions 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 unplanned cardiac reinterventions, and explore modifiable risk factors for and optimal timing of unplanned cardiac reinterventions.</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}