Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Mitral valve repair in the United States: Single-center versus multicenter surgeons’ risk-adjusted outcomes","authors":"Thomas Bilfinger MD, ScD ,&nbsp;Anne Bennett BS ,&nbsp;Thomas A. Bogue MD ,&nbsp;Samuel Greenberg BA ,&nbsp;Joshua Zhu BS ,&nbsp;Joseph Pizzuti BS ,&nbsp;Lee Ann Santore MD ,&nbsp;Samantha Novotny MD ,&nbsp;Jonathan D. Price MD ,&nbsp;Henry J. Tannous MD ,&nbsp;Lichun He MS ,&nbsp;Jie Yang PhD ,&nbsp;A. Laurie Shroyer PhD","doi":"10.1016/j.jtcvs.2025.01.033","DOIUrl":"10.1016/j.jtcvs.2025.01.033","url":null,"abstract":"<div><h3>Objectives</h3><div><span>Health care consolidation may force cardiac surgeons to operate at multiple centers. Few data exist as to this phenomenon's effect upon patients' quality of care as measured by risk-adjusted outcome (RAO) rates. We sought to compare </span>mitral valve repair (MVr) RAO rates between surgeons operating at multiple centers (MC) versus single-centers (SC); and for MC surgeons, to compare MVr RAO rates between their primary and secondary centers.</div></div><div><h3>Methods</h3><div>The 2011-2019 Society of Thoracic Surgeons Adult Cardiac Surgery Database's MVr records were analyzed. MC surgeons performed MVr procedures at ≥2 centers within a year; each MC surgeon's greatest MVr volume (“primary”) center was identified. Applying the Society of Thoracic Surgeons−approved 2018 isolated-MVr risk models, study end points included risk-adjusted 30-day major morbidity or mortality (MMM; determined by operative death, dialysis, stroke, prolonged ventilation, mediastinitis, or repeat procedure) and risk-adjusted prolonged length of stay (pLOS). The impacts of surgeon's and hospital's MVr and total cardiac surgery volumes were evaluated.</div></div><div><h3>Results</h3><div>Compared with MC surgeons, SC surgeons had lower risk-adjusted MMM (odds ratio [OR], 1.170; <em>P</em> &lt; .001). After adjusting for surgeon and center volumes, this finding persisted (OR, 1.141; <em>P</em> = .0155). MC surgeons experienced lower risk-adjusted MMM at their primary versus secondary centers (OR, 1.269; <em>P</em> &lt; .001); this finding was partially attributable to center-based volume variations (OR, 1.130; <em>P</em> = .098). No SC versus MC surgeon risk-adjusted pLOS differences were found; however, regional risk-adjusted pLOS differences persisted.</div></div><div><h3>Conclusions</h3><div>Compared with SC surgeons, reallocating surgeons’ caseload across multiple centers has a statistically significant, negative impact on their MVr RAO rates.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1051-1059.e5"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537950","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":"Routine one-third arch replacement in type 1 acute aortic dissection surgery","authors":"Ayhan Muduroglu MD,&nbsp;Mustafa Selçuk Atasoy MD,&nbsp;Serdar Badem MD,&nbsp;Ahmet Yuksel MD,&nbsp;Yusuf Velioglu MD","doi":"10.1016/j.jtcvs.2024.11.011","DOIUrl":"10.1016/j.jtcvs.2024.11.011","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages e95-e96"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814762","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":"Prognostic impact of low muscle mass on clinical outcomes in patients who undergo lung transplant","authors":"Hyun-Jun Park MD ,&nbsp;Sun Mi Choi MD ,&nbsp;Kwon Joong Na MD ,&nbsp;Samina Park MD ,&nbsp;Hyun Joo Lee MD ,&nbsp;Young Tae Kim MD ,&nbsp;Woo Hyeon Lim MD ,&nbsp;Soon Ho Yoon MD ,&nbsp;Jong Hyuk Lee MD ,&nbsp;Jimyung Park MD","doi":"10.1016/j.jtcvs.2025.03.030","DOIUrl":"10.1016/j.jtcvs.2025.03.030","url":null,"abstract":"<div><h3>Background</h3><div>Low muscle mass (LMM) is recognized as a poor prognostic factor<span> in various chronic lung diseases<span>. However, its prognostic impact on recipients of lung transplants remains inconclusive.</span></span></div></div><div><h3>Methods</h3><div><span>We retrospectively analyzed patients who underwent lung transplantation at a tertiary referral center in South Korea. Pretransplant skeletal muscle mass was quantified at the L1 vertebral level by </span>computed tomography scans of the chest using a commercially available body composition analysis software. Patients were classified into LMM and non-LMM group using a threshold for LMM that had been previously validated in the South Korean population. We then evaluated the prognostic impact of preoperative LMM on clinical outcomes after lung transplantation.</div></div><div><h3>Results</h3><div>A total of 107 patients were included in this analysis, of whom 44 (41.1%) were classified into the LMM group. The median follow-up duration was 958 days posttransplantation. A preoperative LMM was identified as an independent factor associated with a greater risk of overall mortality (adjusted hazard ratio, 2.15; 95% confidence interval, 1.07-4.34). In addition, patients with LMM had a greater risk of developing primary graft dysfunction (adjusted odds ratio, 3.56; 95% confidence interval, 1.25-10.18). At the 1-year follow-up, 37.5% of the patients with baseline LMM had recovered and were reclassified into the non-LMM group, and this improvement was found to mitigate the negative impact of preoperative LMM.</div></div><div><h3>Conclusions</h3><div>Pretransplant LMM was significantly associated with poor clinical outcomes in recipients of lung transplants. These findings highlight the importance of maintaining adequate muscle mass during the waiting period for lung transplantation.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 976-985.e3"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789398","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 scope for work-life integration amidst return-to-work disparity in thoracic surgery","authors":"Nandita Nettu Mahajan MD ,&nbsp;Rajika Jindani MD, MPH, MS ,&nbsp;Laura DiChiacchio MD, PhD","doi":"10.1016/j.jtcvs.2025.05.012","DOIUrl":"10.1016/j.jtcvs.2025.05.012","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Page e92"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286978","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: Subaortic membrane: Not as simple as it seems","authors":"Edward Buratto MBBS, PhD, FRACS ,&nbsp;Igor E. Konstantinov MD, PhD, FRACS","doi":"10.1016/j.jtcvs.2025.06.018","DOIUrl":"10.1016/j.jtcvs.2025.06.018","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1150-1151"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509191","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":"Information for readers","authors":"","doi":"10.1016/S0022-5223(25)00691-9","DOIUrl":"10.1016/S0022-5223(25)00691-9","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Page A15"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189716","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":"Esophageal cancer invading adjacent organs: Esophagectomy combined organ resection may be a good approach","authors":"Rirong Qu MD, PhD,&nbsp;Xiangning Fu MD, PhD","doi":"10.1016/j.jtcvs.2025.01.032","DOIUrl":"10.1016/j.jtcvs.2025.01.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Page e86"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544249","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":"Compassion in cardiothoracic surgery: Essential or just a cherry on top?","authors":"Fayyaz H. Hashmi MBBS,&nbsp;Jennifer S. Lawton MD","doi":"10.1016/j.jtcvs.2024.11.031","DOIUrl":"10.1016/j.jtcvs.2024.11.031","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1135-1138.e1"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774244","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":"How soon will surgeons become mere technicians? Chatbot performance in managing clinical scenarios","authors":"Darren S. Bryan MD ,&nbsp;Joseph J. Platz MD ,&nbsp;Keith S. Naunheim MD ,&nbsp;Mark K. Ferguson MD","doi":"10.1016/j.jtcvs.2024.11.006","DOIUrl":"10.1016/j.jtcvs.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Chatbot<span><span> use has developed a presence in medicine and surgery and has been proposed to help guide clinical decision making. However, the accuracy of information provided by </span>artificial intelligence (AI) platforms has been called into question. We evaluated the performance of 4 popular chatbots on a board-style examination and compared results with a group of board-certified thoracic surgeons.</span></div></div><div><h3>Methods</h3><div><span>Clinical scenarios were developed within domains based on the American Board of Thoracic Surgery (ABTS) Qualifying Exam. Each scenario included 3 stems written with the Key Feature methodology related to diagnosis, evaluation, and treatment. Ten scenarios were presented to ChatGPT-4, Bard (now Gemini), Perplexity, and Claude 2, as well as to randomly selected ABTS-certified surgeons. The maximum possible score was 3 points per scenario. Critical failures were identified during exam development; if they occurred in any of the 3 stems the entire question received a score of 0. The Mann-Whitney </span><em>U</em> test was used to compare surgeon scores and chatbot scores.</div></div><div><h3>Results</h3><div>Examinations were completed by 21 surgeons, the majority of whom (n = 14; 66%) practiced in academic or university settings. The median score per scenario was 1.06 for chatbots, compared to 1.88 for surgeons (difference, 0.66; <em>P</em> = .019). Surgeon median scores were better than chatbot median scores for all except 2 scenarios. Chatbot answers were significantly more likely to be deemed critical failures compared to those provided by surgeons (median, 0.50 per chatbot/scenario vs 0.19 per surgeon/scenario; <em>P</em> = .016).</div></div><div><h3>Conclusions</h3><div>Four popular chatbots performed at a significantly lower level than board-certified surgeons. Implementation of AI should be undertaken with caution in clinical decision making.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1179-1184"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631803","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 fate of aortic valve after surgical repair for discrete membranous subaortic stenosis in pediatric patients","authors":"Jie Dong MD ,&nbsp;Ziping Li MD ,&nbsp;Yangxue Sun MD ,&nbsp;Chuhao Du MD ,&nbsp;Shun Liu MD ,&nbsp;Keming Yang MD, PhD ,&nbsp;Xiangbin Pan MD, PhD ,&nbsp;Shuo Dong MD, PhD","doi":"10.1016/j.jtcvs.2025.05.013","DOIUrl":"10.1016/j.jtcvs.2025.05.013","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to evaluate the long-term outcomes of aortic valve function and identify predictors of significant aortic regurgitation and left ventricular outflow tract obstruction recurrence after surgical repair of discrete membranous subaortic stenosis in pediatric patients and to develop a scoring model for long-term management.</div></div><div><h3>Methods</h3><div>This single-center, retrospective cohort study analyzed 219 pediatric patients who underwent surgical repair for discrete membranous subaortic stenosis between 2008 and 2022. The primary end point was the composite of significant aortic regurgitation and left ventricular outflow tract obstruction recurrence assessed during a median follow-up of 7.0 years. Multivariable Cox regression analysis was used to develop a predictive model validated using bootstrap resampling and calibration plots. A nomogram and risk-stratification model were constructed based on significant predictors.</div></div><div><h3>Results</h3><div>Significant aortic regurgitation occurred in 10.0% of patients, and left ventricular outflow tract obstruction recurrence was observed in 9.59% of patients. The composite end point was experienced by 16.9%, with freedom rates from the end point at 1, 2, 5, and 10 years of 99.5%, 97.7%, 93.4%, and 74.9%, respectively. The final model included discrete membrane accumulation on the aortic valve, preoperative aortic regurgitation grade 3 or greater, peeling from aortic valve, bypass time more than 75 minutes, and postoperative aortic regurgitation grade 2 or greater. The model predicted the outcome with a C-index of 0.814 on the test set and exhibited a significant ability in stratification of patients into low-risk and high-risk groups (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>This study highlights key risk factors for significant aortic regurgitation and left ventricular outflow tract obstruction recurrence after discrete membranous subaortic stenosis surgery in pediatric patients and provides a robust risk-stratification model for clinical decision-making.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 1139-1149.e12"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175281","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}