Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Outcomes of Left Atrioventricular Valve Operation following Atrioventricular Septal Defect Repair.","authors":"Alison J Howell, Devin Chetan, Alvise Guariento, Areeba Zubair, Claudia Almeida, Marisha McClean, Lynne E Nield, Luc Mertens, Chun-Po Steve Fan, David Barron, Osami Honjo","doi":"10.1016/j.jtcvs.2024.09.051","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.051","url":null,"abstract":"<p><strong>Objectives: </strong>Left atrioventricular valve (LAVV) operation following repair of atrioventricular septal defects (AVSD) can be challenging. We sought to describe characteristics and outcomes of patients requiring LAVV operation.</p><p><strong>Methods: </strong>Retrospective review of AVSDs requiring LAVV operation between 2000-2020. Patients who experienced adverse events (AEs; defined as the need for a LAVV reoperation (repair or replacement) or death) were compared to patients without AEs. Freedom from adverse events was displayed using the Kaplan-Meier method. Reoperation and death were characterized in terms of cumulative incidence function, estimated using competing risk models.</p><p><strong>Results: </strong>Of 843 patients with AVSD repaired, 59 (7.3%) required a LAVV operation and 7 (9%) valve replacement. A simple repair (cleft closure and/or annuloplasty) occurred in 26 (48.1%) and complex repair using multiple techniques in 28 (51.8%) cases. Eleven patients (20%) required further LAVV reoperation; 3 replacement of mechanical valve, 6 new valve replacement (2 Melody, 4 Mechanical) and 2 re-repair. The cumulative incidence of freedom from AE was 84.1% (75.0%, 94.2%), 78.3% (68.2%, 90.0%), 73.4% (62.2%, 86.7%), 69.7% (57.5%, 84.7%) at 1, 5, 10 and 15 years respectively. Cox univariable regression showed smaller weight (p=0.027) and early need for LAVV operation (p=0.02) were associated with AEs while cleft closure (p = 0.003) was protective against AEs. The estimated cumulative incidence of reoperation was higher in complex repairs (17.3% (7.8%, 38.7%) vs 0.5% (NA, NA) at 1 year. Greys p = 0.02). In a comparison of eras (2000-2009, 2010- 2020) there was no difference in AE (Greys p = 0.96).</p><p><strong>Conclusions: </strong>Adverse outcomes following LAVV reoperation remain common. Smaller infants, those requiring earlier reoperation and complex type repairs are at highest risk. Future studies should focus on which high risk LAVVs are more suited to early LAVV replacement.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401772","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 influence of the American Association for Thoracic Surgery on clinical trial development by cardiothoracic surgeons.","authors":"Adishesh K Narahari, Taylor M Horgan, Anirudha S Chandrabhatla, Abhinav Kareddy, Ajami Gikandi, Marco A Zenati, David Harpole, David Jones, Leora T Yarboro, Bryan Burt, A Sasha Krupnick, J Hunter Mehaffey","doi":"10.1016/j.jtcvs.2024.09.053","DOIUrl":"10.1016/j.jtcvs.2024.09.053","url":null,"abstract":"<p><strong>Objective: </strong>Clinical trials play a critical role in the rapidly evolving field of cardiothoracic surgery and the American Association for Thoracic Surgery Clinical Trials Methods Course has provided a biannual symposium led by preeminent surgeons with vast experience in planning, conducting, and analyzing surgical clinical trials. This study hypothesizes that participation in the course is associated with future success in clinical trial leadership.</p><p><strong>Methods: </strong>A list of course attendees (2014-2022) was queried in ClinicalTrials.gov, a database of clinical trials funded by the US Department of Health and Human Services and the National Institutes of Health. The type of clinical trial and publications from the trial were collected. Demographic information about the participants was collected from faculty pages.</p><p><strong>Results: </strong>A total of 107 participants from various professional backgrounds attended the American Association for Thoracic Surgery Clinical Trials Methods course and led 91 clinical trials. The average time to starting a clinical trial after attending the workshop was 3.04 years for participants who had not already been involved with a trial. Of the 107 participants, 36 (33.6%) were either the principal investigator or a subinvestigator for 91 clinical trials.</p><p><strong>Conclusions: </strong>The American Association for Thoracic Surgery Clinical Trials Methods course provides participants the tools for successfully leading surgical clinical trials. Although participation has been limited, those who attend the course and lead a clinical trial do so within approximately 3 years. The Clinical Trials Methods Course provides an excellent return on investment and the American Association for Thoracic Surgery should continue sponsorship of this program because it supports the develop of future leaders in cardiothoracic surgery.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394816","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":"Strategic implementation of a new robotic mitral repair program: Early experience and outcomes.","authors":"Max Shin, Jonathan J Szeto, Chase Brown, Omar Toubat, Mark R Helmers, Amit Iyengar, Michael A Acker, Arnar Geirsson, Robert L Smith, Michael E Ibrahim","doi":"10.1016/j.jtcvs.2024.09.052","DOIUrl":"10.1016/j.jtcvs.2024.09.052","url":null,"abstract":"<p><strong>Background: </strong>Despite numerous reported benefits of robotic mitral repair, the absolute number of procedures performed remain low in part to uncertainties about the necessary steps to launch a program. In this report, we describe our early outcomes and strategy with launching a successful new robotic mitral repair program.</p><p><strong>Methods: </strong>Our multimodal strategic plan emphasized team education, hands-on technical preparation, stepwise advancement, and careful patient selection. Consultant service analytics and team debriefings allowed for iterative improvements.</p><p><strong>Results: </strong>Between March 2022 and February 2024, 50 patients underwent robotic mitral repair at our institution. Average age at time of operation was 62 years with a Society of Thoracic Surgeons risk score of 0.58. Successful repairs were performed in 98% of patients. There was 1 conversion to sternotomy. There were no deaths, and there was minimal perioperative morbidity. On both predischarge and follow-up echocardiography, no patients had greater than mild mitral regurgitation.</p><p><strong>Conclusions: </strong>Our work provides a model for establishing a successful robotic mitral program. An up-front emphasis on team education, careful preparation, proper patient selection, and feedback-driven improvements can accelerate the attainment of standards set by high-volume centers.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394815","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":"Impact of aorto-pulmonary and veno-venous collaterals on the onset of plastic bronchitis following the Fontan procedure.","authors":"Takuya Osawa, Thibault Schaeffer, Mervin Schmiel, Michelle Bao Hoa Nguyen Cong, Carolin Niedermaier, Paul Philipp Heinisch, Nicole Piber, Stanimir Georgiev, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1016/j.jtcvs.2024.09.049","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.049","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to clarify the association of the aorto-pulmonary/veno-venous collaterals in patients with plastic bronchitis after the Fontan procedure.</p><p><strong>Methods: </strong>All patients who underwent total cavopulmonary connection from 1994 to 2022 were reviewed. Aorto-pulmonary/veno-venous collaterals were detected using angiograms. The impact of aorto-pulmonary/veno-venous collaterals as well as other variables on the onset of plastic bronchitis were evaluated.</p><p><strong>Results: </strong>A total of 635 patients were included. Plastic bronchitis was observed in 15 (2.4%) patients and the median duration between total cavopulmonary connection and the onset of plastic bronchitis was 1.1 years. Freedom from plastic bronchitis at 5 and 10 years was 97.5 and 96.5%, respectively. As for the association of PB and APCs/VVCs, patients with PB had an increased incidence of post-TCPC APCs (60 vs. 14%, p<0.001) and VVCs (53 vs. 14%, p<0.001). The freedom from plastic bronchitis was the lowest in the patients who were associated with both aortopulmonary collaterals and veno-venous collaterals after total cavopulmonary connection. Aortopulmonary collaterals after total cavopulmonary connection (p=0.002, hazard ratio: 5.729), veno-venous collaterals after total cavopulmonary connection (p=0.016, hazard ratio: 3.527), and chylothorax (p=0.019, hazard ratio: 3.662) were identified as independently associated factors with the onset of plastic bronchitis.</p><p><strong>Conclusions: </strong>The occurrence of post-Fontan aortopulmonary and veno-venous collaterals was significantly associated with the development of plastic bronchitis. Treatment or mitigation of collaterals may represent an opportunity to prevent the development of plastic bronchitis, a remaining source of post-Fontan excess morbidity and mortality.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394814","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: Coarctation and hypertension dilemma unsolved.","authors":"Mohamad Alaeddine","doi":"10.1016/j.jtcvs.2024.09.044","DOIUrl":"10.1016/j.jtcvs.2024.09.044","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382187","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":"Will salvage surgery lead to a paradigm shift in the treatment of stage IV lung cancer?","authors":"Wenjie Yuan, Renjie Huang, Zhang Yang","doi":"10.1016/j.jtcvs.2024.09.013","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.013","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373393","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 Impact of a Residual Atrial Communication in Patients Undergoing Complete Repair for Tetralogy of Fallot: A Propensity Score Matched Analysis.","authors":"Morgan K Moroi, Alice V Vinogradsky, Stephanie N Nguyen, Tarif A Choudhury, Ganga Krishnamurthy, David Kalfa, Emile A Bacha, Stéphanie Levasseur, Andrew B Goldstone","doi":"10.1016/j.jtcvs.2024.09.046","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.046","url":null,"abstract":"<p><strong>Objective: </strong>Surgeons may leave a residual atrial-level communication during complete repair of Tetralogy of Fallot (TOF) in anticipation of restrictive right ventricle physiology or as routine practice. We investigated the impact of closing the interatrial communication at the time of definitive TOF repair.</p><p><strong>Methods: </strong>We retrospectively reviewed TOF patients who underwent definitive repair at <12 months of age between June 2000 and January 2023. Propensity score matching identified 82 patients with a patent interatrial communication and 50 with no interatrial communication on postoperative echocardiography (as-treated analysis). The primary endpoint was maximum vasoactive-inotropic score (VIS) as a surrogate for low cardiac output syndrome.</p><p><strong>Results: </strong>A total of 132 patients (median age: 3.5[IQR,1.8-5.8] months) were matched. There was no difference in maximum VIS (patent interatrial communication: 5.0[IQR, 4.8-9.0] vs. no interatrial communication: 6.0[IQR, 5.0-8.0], P=0.78). Additionally, duration of inotrope therapy (3.0[IQR, 2.0-4.0] vs 3.0[IQR, 1.3-4.0] days, P=0.57), peak lactate (2.2[IQR, 1.9-3.0] vs. 2.3[IQR, 1.9-3.2] mmol/L, P=0.58), time to lactate clearance (0.2[IQR, 0.0-0.3] vs. 0.1[IQR, 0.0-0.3] days, P=0.57), chest tube duration (4.0[IQR,3.0-6.0] vs 4.0[IQR, 3.0-5.0] days, P=0.23), and length of intensive care stay (5.0[IQR, 3.0-7.0] vs. 5.0[IQR, 3.0-7.0] days, P=0.71) were similar. Median follow-up was 5.5[IQR, 2.7-9.9] years. Among patients with a residual communication, patency rates were 93.6% and 53.7% at discharge and latest follow-up, respectively, with most having bidirectional shunting across the defect.</p><p><strong>Conclusions: </strong>Closure of the atrial-level communication during complete TOF repair does not significantly impact the immediate postoperative course or mid-term outcomes. Further investigation is warranted to better understand how patency influences long-term outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378527","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":"Burden of reintervention after tetralogy of Fallot repair: A joint pediatric and adult congenital experience over 30 years.","authors":"Shouka Parvin Nejad, Crystal Tran, Adriana Goraieb, Gazelle Halajha, Sangkavi Kuhan, Sudipta Saha, Marisa Signorile, Chun-Po Steve Fan, David Barron, Erwin Oechslin, Leland Benson, Rachel D Vanderlaan","doi":"10.1016/j.jtcvs.2024.09.042","DOIUrl":"10.1016/j.jtcvs.2024.09.042","url":null,"abstract":"<p><strong>Objective: </strong>There is a high burden of reintervention after repair of tetralogy of Fallot (TOF). We compare procedural burden and late outcomes in valve-sparing repair (VSR) and transannular patch (TAP) cohorts over 30 years.</p><p><strong>Methods: </strong>Patients undergoing TOF repair (1990-2021, excluding complex TOF) were included in this study (n = 1239) with subsequent comparisons between TAP (n = 550) and VSR (n = 648) cohorts. Descriptive statistics, cumulative incidence frequencies, survival analysis, and propensity matching (n = 425) were used to analyze reintervention burden and survival.</p><p><strong>Results: </strong>Overall survival of the cohort was 96.7% at 15 years and 95.6% at 25 years, with similar survival between TAP and VSR cohorts (P = .22). The TAP cohort had increased incidence of procedural burden at 25 years (TAP 69.8% vs VSR 37.2%; P < .001), with 34.6% undergoing ≥2 reinterventions. The TAP cohort had higher incidence of surgical pulmonary valve replacement at 15 years (TAP 20.7% vs VSR 7.6%; P < .001) and placement of pulmonary artery stents (TAP 20.2% vs VSR 4.9%; P < .001). By contrast, VSR had higher incidence of right ventricular outflow tract (RVOT) reoperation at 15 years (VSR 7.3% vs TAP 3.6%; P = .047). After propensity score matching there was no survival advantage between the VSR and TAP cohorts (Era 2), whereas the need for RVOT reoperation was not different between the 2 cohorts (P = .060).</p><p><strong>Conclusions: </strong>The procedural burden remains high following TOF repair. TAP is associated with higher procedural burden in matched and nonmatched cohorts. VSR has increased risk of reoperation for RVOT obstruction only in nonmatched comparisons. Anatomical complexity and surgical repair strategy influence procedural burden following TOF repair.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378525","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":"Comparison of pulmonary artery growth between ductus stent and systemic-to-pulmonary shunt as single-ventricle palliation.","authors":"Dimitrij Grozdanov, Nicole Piber, Kristina Borgmann, Thibault Schaeffer, Takuya Osawa, Jonas Palm, Carolin Niedermaier, Paul Philipp Heinisch, Stanimir Georgiev, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1016/j.jtcvs.2024.09.047","DOIUrl":"10.1016/j.jtcvs.2024.09.047","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to compare the pulmonary artery (PA) growth between infants with univentricular hearts who underwent a ductus stenting (DS) and those who received a systemic to pulmonary shunt (SPS) as an initial palliation.</p><p><strong>Methods: </strong>All infants with ductal-dependent pulmonary blood flow who underwent initial palliation with either a DS or SPS between 2009 and 2022 in our institution were reviewed. PA development was compared between the groups using the PA index and the symmetry index.</p><p><strong>Results: </strong>A total of 130 patients were evaluated including 49 patients after DS and 81 after SPS. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19. At stage II palliation, PA index (P = .926), right PA index (P = .692), left PA index (P = .297), and the symmetry index (P = .650) were similar between the groups. At stage III Fontan completion, PA index (P = .115), right PA index (P = .868), and the symmetry index (P = .144) were similar between the groups. However, left PA index (60 vs 74 mm²/m²; P = .015) was lower, and the incidence of venovenous collaterals (24.2% vs 7.8%; P = .036) was higher in the DS group compared with the SPS group. Freedom from PA interventions between stage II and III palliation was lower in the DS group compared with the SPS group (P = .009).</p><p><strong>Conclusions: </strong>In infants with univentricular heart after DS, freedom from PA interventions after stage II was lower and the left PA index was smaller, compared with those after SPS. Long-term outcomes after the Fontan procedure should be addressed in patients after DS.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378526","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: Utilizing donation after circulatory death donors for patients supported on left ventricular assist devices: Is it safe?","authors":"Valluvan Jeevanandam","doi":"10.1016/j.jtcvs.2024.09.045","DOIUrl":"10.1016/j.jtcvs.2024.09.045","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373391","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}