Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Initial Patient Characteristics of TSOG 102: A Multicenter Prospective Registry of Active Surveillance in Patients with Multiple Ground Glass Opacities.","authors":"James Huang, Kay See Tan, Nasser Altorki, Mara Antonoff, Shanda Blackmon, Raphael Bueno, Bryan Burt, Todd Demmy, Nathaniel Evans, Laura Donahoe, David Harpole, Doraid Jarrar, Benjamin Kozower, Michael Lanuti, Moishe Liberman, Jules Lin, Douglas Liou, Michael Liptay, James Luketich, Arjun Pennathur, Gerard Petersen, Robert Ripley, Matthew Rochefort, Christopher W Seder, Joseph Shrager, Stacey Su, Betty Tong, Yaron Shargall, Ara Vaporciyan, Thomas Waddell, Benny Weksler, Dennis Wigle, Sai Yendamuri, David R Jones","doi":"10.1016/j.jtcvs.2024.09.054","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.054","url":null,"abstract":"<p><strong>Objective: </strong>Presentation with multiple ground glass opacities (GGOs) is an increasingly common occurrence, and the optimal management of these lesions is unclear. Active surveillance has been increasingly adopted as a management strategy for other low-grade malignancies. We hypothesized that active surveillance could be a feasible and safe option for patients with multiple GGOs.</p><p><strong>Methods: </strong>Patients with ≥2 GGOs (ground glass predominant, <50% solid, ≤3 cm) were enrolled in a multi-institutional registry and prospectively followed up on active surveillance with computed tomography scans every 6 to 12 months. Each GGO was catalogued and measured individually at each follow-up visit.</p><p><strong>Results: </strong>Target accrual was met, with 337 patients from 23 institutions. The mean age was 70 years (interquartile range, 65-77 years), and 74% were women. Most were former (70%) or current (9%) smokers, with a mean exposure of 30 pack-years (interquartile range [IQR], 15-44 pack-years). Half of the patients (51%) had a previous lung cancer, and the majority (86%) were already under surveillance at the time of study entry. The median number of GGOs per patient was 3 (IQR, 2-5), with a total of 1467 GGOs under surveillance. The median GGO size was 0.9 cm (IQR, 0.7-1.3 cm). Most GGOs were 0.5 to 1 cm in size.</p><p><strong>Conclusions: </strong>Active surveillance, rather than immediate intervention, was an acceptable option to patients, and accrual to this registry trial was feasible. Safety endpoints and long-term outcomes will be assessed in the planned 5-year follow-up in accordance with the protocol.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479290","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":"Harmonizing guidelines and other clinical practice documents: A joint comprehensive methodology manual by the American Association for Thoracic Surgery (AATS), European Association for Cardio-Thoracic Surgery (EACTS), European Society of Thoracic Surgeons (ESTS), and Society of Thoracic Surgeons (STS).","authors":"Milan Milojevic, Nick Freemantle, J W Awori Hayanga, Rosemary F Kelly, Patrick O Myers, René Horsleben Petersen, Isabelle Opitz, Joseph F Sabik, Faisal G Bakaeen","doi":"10.1016/j.jtcvs.2024.07.048","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.07.048","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479288","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":"Soluble Mesothelin-Related Peptide as a Prognosticator in Pleural Mesothelioma Patients Receiving Checkpoint Immunotherapy.","authors":"Sonali Mitra, Hee-Jin Jang, Allen Kuncheria, Sung Wook Kang, Jong Min Choi, Ji Seon Shim, Claire Lee, Priyanka Ranchod, Peter Jindra, Maheshwari Raminei, Meera Patel, R Taylor Ripley, Shawn Groth, Shanda H Blackmon, Bryan M Burt, Hyun-Sung Lee","doi":"10.1016/j.jtcvs.2024.10.005","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.005","url":null,"abstract":"<p><strong>Objective: </strong>Immune checkpoint therapy (ICT) has significantly impacted malignant pleural mesothelioma (MPM) treatment. Despite some promising results from combination therapies, nearly half of MPM patients do not benefit, underscoring the urgent need for reliable predictive biomarkers. This study assesses the prognostic value of serum soluble mesothelin-related peptide (SMRP) and PD-L1 levels in MPM patients receiving ICT.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 125 MPM patients treated with ICT by measuring pre-ICT serum levels of SMRP and PD-L1. We also examined the correlation of these serum levels with tumor mRNA expressions of MSLN and PD-L1. Both univariable and multivariable Cox regression analyses were used to determine independent prognosticators for overall survival (OS). A prospective ICT clinical trial and our historical cohort were included for validation.</p><p><strong>Results: </strong>Seventy-seven patients (62%) were treated with either anti-PD-(L)1 monotherapy, and the remaining 38% were given combination ICT. Higher pre-ICT SMRP levels were observed in epithelioid versus non-epithelioid MPM. Serum PD-L1 levels did not show significant differences between the groups. Univariable analysis identified durable clinical benefit, development of immune-related adverse events, and SMRP levels as significantly associated with OS. Multivariable analysis confirmed SMRP as an independent prognostic factor, with lower levels (≤1.35 nmol/L) correlating with improved OS. The association of high SMRP with worse prognosis was validated in the prospective ICT clinical trial cohort and not in our historical cohort treated without ICT.</p><p><strong>Conclusions: </strong>SMRP is a promising serum biomarker for predicting survival in MPM patients treated with ICT and warrants prospective investigation.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479294","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":"Differences in chronic lung allograft dysfunction between deceased-donor lung transplantation and living-donor lobar lung transplantation.","authors":"Satona Tanaka, Mamoru Takahashi, Hidenao Kayawake, Yojiro Yutaka, Akihiro Ohsumi, Daisuke Nakajima, Kohei Ikezoe, Kiminobu Tanizawa, Tomohiro Handa, Hiroshi Date","doi":"10.1016/j.jtcvs.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.004","url":null,"abstract":"<p><strong>Objective: </strong>This study explored the characteristics and prognostic impact of chronic lung allograft dysfunction (CLAD) after deceased-donor lung transplantation and living-donor lobar lung transplantation, wherein the lower lobes from two donors are usually transplanted into one recipient.</p><p><strong>Methods: </strong>The clinical data of 123 deceased-donor and 67 living-donor lung transplantations performed in adult patients at our institution between June 2008 and September 2019 were retrospectively reviewed. The cumulative incidence of CLAD was evaluated on a per-recipient and per-donor graft basis using the Kaplan-Meier method.</p><p><strong>Results: </strong>The smaller number of human leukocyte antigen mismatches, shorter ischemic time, and lower incidence of grade 3 primary graft dysfunction were observed in living-donor transplantation than in deceased-donor transplantation (p<0.001). Restrictive allograft syndrome (RAS)-type CLAD occurred in 9 (20.9%) of 43 CLAD patients after deceased-donor transplantation and 9 (45.0%) of 20 CLAD patients after living-donor transplantation. CLAD occurred unilaterally in 15 patients (75.0%) after bilateral living-donor transplantation. Despite the higher incidence of RAS-type CLAD after living-donor transplantation, the overall survival rates after the transplantation and survival rates after the onset of CLAD were comparable between the deceased-donor transplant and living-donor transplant patients. The cumulative incidence of CLAD per recipient was similar between the deceased-donor and the living-donor transplant recipients (p=0.32). In the per-donor graft analysis, the cumulative incidence of CLAD was significantly lower in the living-donor grafts than in the deceased-donor grafts (p=0.003).</p><p><strong>Conclusions: </strong>The manifestation of CLAD after living-donor lobar lung transplantation is unique and differs from that after deceased-donor lung transplantation.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407120","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":"Clinical features and postoperative outcomes in elderly patients undergoing septal myectomy for hypertrophic cardiomyopathy.","authors":"Tedy Sawma, Hartzell V Schaff, Fernando Juarez-Casso, Serena Rahme, Austin Todd, Joseph A Dearani, Gabor Bagameri, Steve R Ommen, Jeffrey B Geske","doi":"10.1016/j.jtcvs.2024.09.050","DOIUrl":"10.1016/j.jtcvs.2024.09.050","url":null,"abstract":"<p><strong>Objectives: </strong>Surgical septal reduction is sometimes avoided in older adults due to anticipated high operative risk. The study objectives were to compare the clinical and echocardiographic characteristics of young and older patients undergoing septal myectomy for obstructive hypertrophic cardiomyopathy and assess differences in early and late postoperative outcomes.</p><p><strong>Methods: </strong>A total of 2663 patients with obstructive hypertrophic cardiomyopathy underwent transaortic septal myectomy between 2000 and 2021 and were categorized by age: 18 to 64 years, 65 to 74 years, and 75 years or more.</p><p><strong>Results: </strong>Median age at the time of surgery increased over the study interval. Female sex (P < .001), hypertension P < .001), and diabetes (P = .004) were more prevalent in older patients, but extent of functional limitation (New York Heart Association) was similar (P = .092). Elderly patients had thinner septal and posterior walls (P < .001, P = .006) and less prominent asymmetry (P < .001). They are less likely to have positive genetic testing. Hospital mortality was 0.2%, 0.5%, and 1.3% in patients aged less than 65 years, 65 to 74 years, and 75 years or more, respectively (P = .06), and 5-year survivals were 97%, 93%, and 91%, respectively. Septal-to-posterior wall thickness ratio significantly correlated with increased mortality in patients aged more than 65 years, but not in patients aged less than 65 years (P = .92). Most of the patients reported improved quality of life after myectomy.</p><p><strong>Conclusions: </strong>Clinical characteristics of obstructive hypertrophic cardiomyopathy in older patients differ from those in younger patients. More symmetric but less extensive ventricular hypertrophy and less positive genetic testing suggests that hypertrophic cardiomyopathy has distinct clinical and morphological variants in the elderly. Septal myectomy is safe in older patients, but the presence of left ventricular wall asymmetry portends a poorer prognosis.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401771","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":"Bloodless Lung Transplantation: Comparison Between Two Central Venoarterial ECMO Anticoagulation Strategies and Their Impact on Lung Transplant Outcomes.","authors":"Ernest G Chan, Rachel Deitz, John P Ryan, Yota Suzuki, Chadi A Hage, Masashi Furukawa, Kentaro Noda, Kathirvel Subramaniam, Pablo G Sanchez","doi":"10.1016/j.jtcvs.2024.09.055","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.055","url":null,"abstract":"<p><strong>Objective: </strong>We report differences between two anticoagulation protocols during VA-ECMO intraoperative support and their effects on outcomes following lung transplantation.</p><p><strong>Methods: </strong>We performed a retrospective analysis of patients undergoing double lung transplantation with intraoperative VA-ECMO from 1/1/2016 - 12/30/2023. Two distinct anticoagulation protocols were in place during this period. One included targeted ACT > 180s at all times with protamine reversal after decannulation. The second included 75 Ui of heparin at the time of cannulation with no redosing plus a TXA infusion after ECMO initiation.</p><p><strong>Results: </strong>A total of 116 patients (46 low heparin, 70 standard) were included in the analysis. Cannulation strategies and ECMO circuit were equivalent between the groups. The low heparin protocol group had a shorter surgical time (7.28 vs 8.53 hours, p<0.001) and required significantly less intraoperative pRBC (median 4.37 vs. 0 units p<0.001), FFP (median 2 vs 0 units, p<0.001), platelets (median 1 vs 0 units, p<0.001), cryoprecipitate (median 0 vs 0 units, p<0.001), and total blood products (median 9 vs 0 units, p<0.001) compared to the standard group. There were no differences in rates of DVT (p=0.13), airway dehiscence (p>0.99), pneumonia (p=0.38), or acute kidney injury require renal replacement therapy (p=0.59). There was no difference in rates of severe grade 3 PGD at 72 hours post-transplant (p=0.42).</p><p><strong>Conclusion: </strong>Our low heparin VA-ECMO protocol for intraoperative support during lung transplantation led to a significant reduction of blood product utilization. While this did not translate to a reduced PGD 3 rates, the low heparin protocol was associated with similar post-operative outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407118","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: Achieving environmental justice will reduce lung cancer health disparities.","authors":"Hollis Hutchings, Haroutioun Boyajian, Ikenna Okereke","doi":"10.1016/j.jtcvs.2024.08.032","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.08.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479293","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":"Adoption of a Semi-elective Lung Transplantation Practice by Safely Extending Cold Ischemic Times.","authors":"Rachel L Deitz, Ernest G Chan, John P Ryan, Jenalee N Coster, Masashi Furukawa, Chadi A Hage, Pablo G Sanchez","doi":"10.1016/j.jtcvs.2024.09.038","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.038","url":null,"abstract":"<p><strong>Objective: </strong>Lung transplantation is a complex surgical procedure performed by specialized teams. Practice changes to eliminate overnight lung transplants were implemented at our center and patient outcomes were evaluated.</p><p><strong>Methods: </strong>Patient and donor organ selection were performed in the standard fashion. All donors with a cross clamp after 6 PM matched to any of our listed recipients-independent of their surgical complexity or risk-were kept in a temperature-controlled iceless cooler from procurement to recipient implant. All recipients had a 7 AM in-room start. Data were prospectively collected and compared to a cohort of recipients from the previous fifteen months.</p><p><strong>Results: </strong>82 transplants were performed at a single academic institution between 7/1/22 and 1/7/24, 21% of which included allografts with extended ischemic times utilizing the iceless cooler (n=18) with a median average temperature of 6.81 degrees Celsius. Median ischemic times were 13.9 (12.5 - 15.6) hours, more than twice the length of ischemic times in the standard group (n=64, 6.8 (6.1 - 7.4) hours). Post-operative outcomes were similar between groups, including post-operative ICU duration (12 vs 9 days in the standard group), length of stay (24 vs 20 days), PGD3 (17% vs 20%), post-operative ECMO (22% vs 20%), and six-month survival (94% vs 91%).</p><p><strong>Conclusions: </strong>Donor lungs preserved in an iceless cooler were successfully transplanted after extended cold ischemic times. Adoption of a semi-elective transplant strategy can be successfully implemented without compromising patient outcomes. Additional advantages may be gleaned through daytime transplantation with standard transplant surgical teams rather than overnight, on call-teams.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407117","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: Cutting Through the Noise - Can Natural Language Processing Improve Literature Review in Cardiac Surgery?","authors":"Kyle W Blackburn, Subhasis Chatterjee","doi":"10.1016/j.jtcvs.2024.10.006","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.10.006","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407119","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: Survival, function, and immune profiling after beating heart transplantation.","authors":"","doi":"10.1016/j.jtcvs.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.005","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479284","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}