Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Wide variation in mitral valve repair rates among US surgeons: Analysis of Medicare claims data","authors":"Hanghang Wang MD, PhD ,&nbsp;Chen Dun MS ,&nbsp;Martin A. Makary MD, MPH ,&nbsp;Christi Walsh MS ,&nbsp;Yi Fan PhD ,&nbsp;Emily Rodriguez BS ,&nbsp;Deven Patel MD, MS ,&nbsp;Alice Zhou MS ,&nbsp;Armaan Akbar BS ,&nbsp;Glenn Whitman MD ,&nbsp;James S. Gammie MD","doi":"10.1016/j.jtcvs.2024.10.035","DOIUrl":"10.1016/j.jtcvs.2024.10.035","url":null,"abstract":"<div><h3>Objective</h3><div>Mitral valve repair<span> is the preferred treatment for primary mitral regurgitation<span> and offers significant short- and long-term advantages over valve replacement. This study was designed to evaluate the contemporary national mitral valve surgery practice patterns, focusing on the impact of surgeon-specific factors, such as operative volume and years of practice, on repair rates.</span></span></div></div><div><h3>Methods</h3><div><span>A retrospective analysis was conducted using 100% Medicare fee-for-service claims data over a 3-year period (January 2020 to December 2022). Mitral valve<span> procedures were identified using specific Current Procedural Terminology codes. We excluded patients with active infective endocarditis, </span></span>mitral stenosis, or a history of previous mitral valve repair or replacement. Multivariable binomial regression was used to assess the impact of surgeon-specific factors on repair rates.</div></div><div><h3>Results</h3><div>We identified 2072 surgeons in 770 hospitals who performed 12,339 mitral valve operations, with an overall repair rate of 68.8%. The median number of mitral valve operations performed per surgeon during the 3-year study period was 3 (interquartile range [IQR], 2-7), and the median number of mitral valve repairs was 2 (IQR, 1-5). A subset of 312 surgeons (15%) performed more than 10 mitral valve procedures each and more than one half (57%) of all repairs nationally. This subgroup's median repair rate was 77%, with significant variability within the group: 17% of surgeons had a repair rate below 50%, 59% had a repair rate between 50% and 90%, and 24% had a repair rate greater than 90%. Multivariable regression analysis indicated significant associations between repair rates and surgeon-specific factors, including surgical volume, years of practice, and region of practice. Each additional procedure was associated with a 1.5% average increase in repair rate likelihood (95% confidence interval, 1.2%-1.8%, <em>P</em> &lt; .001), and each additional year of practice was associated with a 1.4% average increase (95% confidence interval, 0.8%-2%, <em>P</em> &lt; .001). Regional differences were notable: surgeons in the South demonstrated lower repair rates (median 71%; IQR, 55%-85%) compared with those in the Northeast (median, 78%; IQR, 68%-91%, <em>P</em> = .02) and Midwest (median 86%; IQR, 63%-92%, <em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>This study has identified significant variability in mitral valve repair rates among surgeons who treat Medicare beneficiaries. Notably, even among the surgeons responsible for most of these procedures, the variability in repair rates is pronounced. These findings suggest substantial opportunities to improve outcomes for patients undergoing mitral valve operations in North America.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1041-1048.e1"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512047","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":"A multicenter analysis of aortic root replacement: Non-native chest increases risk of postoperative mortality","authors":"Adam M. Carroll MD, MPH ,&nbsp;Michael J. Kirsch MD ,&nbsp;Fenton H. McCarthy MD ,&nbsp;Jason P. Glotzbach MD ,&nbsp;Christopher R. Burke MD ,&nbsp;Markian Bojko MD ,&nbsp;Fernando Fleischman MD ,&nbsp;T. Brett Reece MD, MBA ,&nbsp;Anthony Caffarelli MD","doi":"10.1016/j.jtcvs.2024.11.018","DOIUrl":"10.1016/j.jtcvs.2024.11.018","url":null,"abstract":"<div><h3>Objective</h3><div>Re-do root replacement poses a significant technical challenge, increasing the potential risk of morbidity and mortality. This multi-institution study compared the outcomes of aortic root replacement<span> stratified by chest surgery<span> and aortic root history.</span></span></div></div><div><h3>Methods</h3><div>A retrospective review by the Western Aortic Collaborative was performed of 3 different aortic centers for patients who underwent nonemergency root replacement from 2017 to 2023 with exclusion of patients who underwent more than hemiarch replacement or presented with acute or hyperacute aortic dissection<span>. Patients were stratified into 3 cohorts: native chest, prior sternotomy<span> with no previous root replacement, and true re-do root replacement. Univariate and multivariable logistic regression was performed for the primary end point of in-hospital or 30-day mortality and secondary end points.</span></span></div></div><div><h3>Results</h3><div>A total of 568 patients underwent elective or urgent root replacement, with 338 (59.5%) in the native chest cohort, 165 (29.1%) in the no previous root replacement cohort, and 65 (11.4%) in the true re-do root replacement cohort. The no previous root replacement and true re-do root replacement cohorts were more likely to undergo nonvalve-sparing root replacement (<em>P</em><span> &lt; .001) and concomitant coronary artery bypass grafting (</span><em>P</em> = .002) and less likely to undergo hemiarch repair (<em>P</em> &lt; .001). Multivariable analysis showed additional risk associated with prior sternotomy, rather than having a previous root performed.</div></div><div><h3>Conclusions</h3><div>Patients undergoing root replacement in a non-native chest have a significant risk of morbidity and mortality. However, prior root and true re-do root replacement do not appear to add additional risk, with primary risk contributed by operating in a prior surgical field.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 986-993.e2"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710744","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 outcomes in total arch replacement combined with frozen elephant trunk for acute type A aortic dissection","authors":"Kai Zhang MD ,&nbsp;Juntao Qiu MD ,&nbsp;Jinlin Wu MD ,&nbsp;Chenyu Zhou MD ,&nbsp;Yumeng Ji MD ,&nbsp;Enzehua Xie MD ,&nbsp;Shiqi Gao MD ,&nbsp;Bin Hou MD ,&nbsp;Han Li MD ,&nbsp;Qian Chang MD ,&nbsp;Xiangyang Qian MD ,&nbsp;Xiaogang Sun MD ,&nbsp;Cuntao Yu MD","doi":"10.1016/j.jtcvs.2024.11.025","DOIUrl":"10.1016/j.jtcvs.2024.11.025","url":null,"abstract":"<div><h3>Objective</h3><div>The optimal surgical approach for acute type A aortic dissection<span><span> involving the aortic arch remains controversial. This study aims to evaluate the long-term outcomes of acute type A </span>aortic dissection treated with total arch replacement combined with frozen elephant trunk implantation in a large single-center cohort.</span></div></div><div><h3>Methods</h3><div><span>From 2010 to 2022, patients with acute type A aortic dissection who received total arch replacement with frozen elephant trunk implantation at Fuwai Hospital were selected for clinical data collection<span> and long-term follow-up. Logistic regression<span> and Cox regression<span> analyses were performed to identify risk factors for operative mortality, long-term mortality, and </span></span></span></span>reoperation.</div></div><div><h3>Results</h3><div>A total of 1672 patients underwent total arch replacement with frozen elephant trunk implantation, of whom 79.9% (1336/1672) were male with a median age of 48 years. The operative mortality rate was 6.3% (105/1672). The 10-year survival was 81.4%, and the most extended follow-up was over 13 years. Among the survivors, 89.7% (1303/1453) had complete self-care ability and were able to engage in general physical work. The 10-year cumulative incidence of reoperation was 13.3%. Multivariable logistic regression analysis revealed that male gender was associated with a reduced risk of operative death (odds ratio, 0.95, 95% CI, 0.92-0.98) and long-term death (hazard ratio, 0.68, 95% CI, 0.48-0.96).</div></div><div><h3>Conclusions</h3><div><span>Total arch replacement with frozen elephant trunk implantation demonstrates acceptable operative mortality and promising long-term outcomes for acute type A aortic dissection. Female patients face higher risks of operative and long-term mortality compared with male patients. Total arch replacement with frozen elephant trunk implantation provides patients with encouraging long-term </span>quality of life and is advisable for acute type A aortic dissection in experienced centers.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 994-1005.e9"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741143","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: Going small should not—and does not—compromise quality","authors":"Luke J. Rogers MBChB, BSc, MRCS, FRCS (CTh) ,&nbsp;Piroze M. Davierwala MD, MS, MCh (CVTS)","doi":"10.1016/j.jtcvs.2024.12.014","DOIUrl":"10.1016/j.jtcvs.2024.12.014","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1096-1097"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873292","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: Nature versus nurture in adult congenital heart disease","authors":"Tracy R. Geoffrion MD, MPH, FACS","doi":"10.1016/j.jtcvs.2025.03.022","DOIUrl":"10.1016/j.jtcvs.2025.03.022","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1176-1177"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774673","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":"An adolescent with severe aortic regurgitation and aortic root dilatation","authors":"Igor E. Konstantinov MD, PhD, FRACS ,&nbsp;Carolina Rodrigues MD ,&nbsp;Sergei I. Konstantinov BBioMed ,&nbsp;Tyson A. Fricke MBBS, PhD, FRACS","doi":"10.1016/j.jtcvs.2025.04.012","DOIUrl":"10.1016/j.jtcvs.2025.04.012","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages e99-e102"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992718","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":"Diagnostic effectiveness and safety of robotic-assisted bronchoscopy for subsolid pulmonary nodules: A multicenter prospective observational study","authors":"Camilla Gomes MD, MS ,&nbsp;Brandon Cowan MD ,&nbsp;Mengqi Xiao MS, BS ,&nbsp;Paul Morris MD ,&nbsp;Damaris Pederson MPH ,&nbsp;Kazuhiro Yasufuku MD, PhD","doi":"10.1016/j.jtcvs.2025.05.021","DOIUrl":"10.1016/j.jtcvs.2025.05.021","url":null,"abstract":"<div><h3>Objective</h3><div>To analyze the effectiveness and safety of robotic-assisted bronchoscopy (RAB) for subsolid nodules, including semisolid nodules (SSNs) and ground-glass nodules (GGNs).</div></div><div><h3>Methods</h3><div>This is a subset analysis of a multicenter, prospective observational study that investigated patients with subsolid nodules undergoing RAB. Effectiveness was defined by reach, measured by radial endobronchial ultrasound (rEBUS) confirmation and median distance from bronchoscope tip to the lesion prior to biopsy, and access, measured by sensitivity for malignancy and diagnostic yield (DY). Adverse events were recorded to assess safety.</div></div><div><h3>Results</h3><div>Of 679 patients analyzed, 91 (13.4%) had subsolid nodules, including 78 with SSNs and 13 with pure GGNs. The median subsolid nodule size was 18.5 mm, 61.5% were in the upper lobes, and 89.0% were in the outer two-thirds of the lung. The malignancy rate was 45.1%, predominantly adenocarcinoma. rEBUS localization rates were 81.4% for SSNs and 61.5% for GGNs, with median distance from the bronchoscope tip of 22.0 mm and 19.5 mm, respectively. Sensitivity for malignancy was 77.8% for SSNs and 75.0% for GGNs, while the strict DY was 50.0% and 61.5%, respectively. Nondiagnostic results occurred in 31 subsolid nodules (34.1%) at the index biopsy. The incidence of pneumothorax was 4.4% and that of pneumothorax necessitating a chest tube was 2.2% in the subsolid nodule cohort. No bleeding, respiratory complications, or mortalities were reported in the subsolid nodule cohort during the 7-day follow-up period.</div></div><div><h3>Conclusions</h3><div>Our findings confirm that RAB is safe and effective for diagnosing subsolid nodules.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 945-954"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259255","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 extent of lymph node dissection is not associated with disease-free survival following lobar or sublobar resection: Results from Cancer and Leukemia Group B 140503 (Alliance)","authors":"Nasser Altorki MD ,&nbsp;Bryce Damman MS ,&nbsp;Xiaofei Wang PhD ,&nbsp;Moishe Liberman MD, PhD ,&nbsp;Dennis Wigle MD, PhD ,&nbsp;Ahmad Ashrafi MD ,&nbsp;Massimo Conti MD ,&nbsp;Kazuhiro Yasufuku MD, PhD ,&nbsp;Matthew J. Schuchert MD ,&nbsp;Thomas E. Stinchcombe MD","doi":"10.1016/j.jtcvs.2025.06.007","DOIUrl":"10.1016/j.jtcvs.2025.06.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;The extent of lymphadenectomy in patients with c-stage I non–small cell lung cancer is controversial. Cancer and Leukemia Group B 140503 (Alliance; NCT00499330) randomized patients with peripheral clinical stage 1A non–small cell lung cancer 2 cm or less to lobar or sublobar resection after frozen-section examination of 2 &lt;/span&gt;mediastinal nodes and 1 major hilar node (simple sampling) confirmed the &lt;/span&gt;absence&lt;span&gt; of nodal metastases. Additional node dissection was performed at the surgeon's discretion and included simple sampling, systematic sampling, or complete lymph node dissection. We report the impact of the extent of lymphadenectomy on disease- and recurrence-free survival in this trial.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Between June 2007 and March 2017, 697 patients were randomized to lobar resection (357) or sublobar resection (340). Data on the extent of lymphadenectomy were available on 689 patients: A total of 182 patients had complete lymph node dissection, 349 patients had systematic sampling, and 158 patients had simple sampling. Disease-free survival was defined as the time to lung cancer recurrence&lt;span&gt;&lt;span&gt; or all-cause mortality. Recurrence-free survival was defined as the time to lung cancer recurrence or death from lung cancer. Survival end points were estimated using the Kaplan–Meier method. Stratified Cox &lt;/span&gt;proportional hazards models estimated hazard ratios and their CIs.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Baseline characteristics were generally similar between groups. Five-year disease-free survival was 62.3% (95% CI, 55.2-70.4) after complete lymph node dissection, 65.7% (95% CI, 60.7-71.2) after systematic sampling, and 61.2% (95% CI, 53.7-69.7) after simple sampling. Disease-free survival was not statistically significantly different between lobar resection and sublobar resection based on the extent of node dissection. Five-year disease-free survival among patients who had complete lymph node dissection was 65.7% (95% CI, 56.4-76.6) after lobar resection and 58.5% (95% CI, 48.2-71.1) after sublobar resection (&lt;em&gt;P = .&lt;/em&gt;530). Five-year disease-free survival in patients who had simple sampling/systematic sampling was 63.5% (95% CI, 57.6-70.0) after lobar resection and 65.1% (95% CI, 59.2-71.6) after sublobar resection. Five-year recurrence-free survival for patients who had complete lymph node dissection was 72.5% (95% CI, 63.5-82.9) after lobar resection and 68.9% (95% CI, 59.0-80.5) after sublobar resection (&lt;em&gt;P = .&lt;/em&gt;526). Five-year recurrence-free survival in patients who had simple sampling/systematic sampling was 70.8% (95% CI, 65.0-77.0) after lobar resection and 70.2% (95% CI, 64.4-76.5) after sublobar resection (&lt;em&gt;P = .&lt;/em&gt;604). There was no difference between groups in the incidence of systemic recurrence or isolated hilar, mediastinal, or supraclavicular nodal recurrence.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In patients wit","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 933-942.e2"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327587","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: Embracing change to provide patients with better care","authors":"Robert James Cerfolio MD, MBA","doi":"10.1016/j.jtcvs.2025.06.030","DOIUrl":"10.1016/j.jtcvs.2025.06.030","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 955-956"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568058","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: Looking to the future: Revisiting the volume-outcome relationship in mitral valve repair","authors":"Amit Iyengar MD, MS,&nbsp;Cindy Song BA,&nbsp;Pavan Atluri MD","doi":"10.1016/j.jtcvs.2025.02.020","DOIUrl":"10.1016/j.jtcvs.2025.02.020","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1049-1050"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537945","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}