Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Ventricular septation for double inlet ventricle: Avoiding conduction injury.","authors":"Ajami Gikandi, Jocelyn Davee, Edward T O'Leary, Elizabeth S DeWitt, Sunil J Ghelani, Rebecca S Beroukhim, Edward P Walsh, Pedro J Del Nido, Eric N Feins, Sitaram M Emani","doi":"10.1016/j.jtcvs.2024.09.036","DOIUrl":"10.1016/j.jtcvs.2024.09.036","url":null,"abstract":"<p><strong>Objectives: </strong>Although conduction location can be reliably predicted in double inlet ventricle, ventricular septation continues to carry a significant risk of complete heart block. This study describes our experience using intraoperative conduction mapping during ventricular septation.</p><p><strong>Methods: </strong>Patients undergoing ventricular septation from 2017 to 2023 were identified. Conduction mapping was performed on the open, decompressed, beating heart to identify the His bundle. Mapped His bundle locations were compared with those predicted from magnetic resonance imaging diagnoses by a senior pediatric cardiac electrophysiologist blinded to mapping results.</p><p><strong>Results: </strong>Ventricular septation was performed in 31 patients, 25 with hypoplastic right ventricles and 6 with hypoplastic left ventricles. Two-stage septation was performed in 25 patients, and single-stage septation was performed in 6 patients. Mapped conduction location was performed in the last 25 consecutive patients. Mapped conduction location was concordant with expected location in 21 of 22 patients with predictions. Complete heart block requiring a permanent pacemaker occurred in 4 patients despite successful mapping, whereas 10 patients required other reoperations, most commonly to address residual atrioventricular valve regurgitation or subpulmonary obstruction from the ventricular septal defect patch. There has been no perioperative mortality, need for single-ventricle palliation, or heart transplantation. All 13 patients who have progressed to complete septation and 18 patients with interstage circulation have acceptable hemodynamics, preserved ventricular function, and no heart failure symptoms at latest follow-up.</p><p><strong>Conclusions: </strong>Ventricular septation represents an alternative to the Fontan that can be performed safely in a subset of patients with acceptable early outcomes. Conduction mapping is an adjunct strategy that may add precision to well-established rules for reliably predicting conduction location.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331344","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: Reproductive rights legislation impacts cardiothoracic surgery training options.","authors":"","doi":"10.1016/j.jtcvs.2024.08.021","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.08.021","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331330","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":"Racial differences in cardiothoracic surgery letters of recommendation.","authors":"Kaleb Rostmeyer, Valeda Yong, Mengying Deng, Kristine Chin, Lynde Lutzow, Kadir Erkmen, Cherie P Erkmen","doi":"10.1016/j.jtcvs.2024.09.037","DOIUrl":"10.1016/j.jtcvs.2024.09.037","url":null,"abstract":"<p><strong>Objective: </strong>Cardiothoracic surgery lacks racial diversity. Attracting the best candidates requires valuing diversity and advancing a recruitment process that minimizes racial bias. Implicit bias in recommendation letters has been identified as an influential mechanism for lack of diversity in cardiothoracic surgery. We aim to investigate how applicant race impacts language used in cardiothoracic surgery fellowship recommendation letters.</p><p><strong>Methods: </strong>We examined applications to an accredited cardiothoracic surgery fellowship program between 2017 and 2021. Recommendation letter authors were categorized as cardiothoracic and noncardiothoracic surgeons. Applicant self-reported race was dichotomized as White and non-White. Applicant characteristics were described using standard descriptive statistics and compared between applicant race. Recommendation letters were examined with linguistic analysis software and higher-level analysis to assess language associations between applicant race and author specialty.</p><p><strong>Results: </strong>A total of 597 recommendation letters were analyzed from 158 individual applications. Cardiothoracic surgeons composed 334 (55.9%) recommendation letters. A total of 95 applicants (60.1%) were categorized as White. White applicants were described as more driven (P = .03), whereas letters for non-White applicants were more authentic (P = .02) and highlighted past experiences (P = .05). Cardiothoracic surgeons wrote longer letters (P = .04) with standout adjectives (P = .03) more frequently for White applicants and emphasized perceptiveness (P = .02) more often when writing for non-White applicants.</p><p><strong>Conclusions: </strong>We demonstrate that authors' recommendation letters are influenced by applicant race. Letters written for White candidates are significantly longer and more descriptive of drive and outstanding characteristics than letters written for non-White candidates, particularly when written by cardiothoracic surgeons. Addressing this bias is crucial for recruiting the best candidates for cardiothoracic surgery.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331340","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":"Chest wall resection and reconstruction for primary chest wall sarcomas: Analysis of survival, predictors of outcome, and long-term functional status.","authors":"Alina-Maria Budacan, Akshay J Patel, Pavithra Babu, Haitham Khalil, Sumathi Vaiyapuri, Michael Parry, Maninder S Kalkat","doi":"10.1016/j.jtcvs.2024.09.035","DOIUrl":"10.1016/j.jtcvs.2024.09.035","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to analyze survival, predictors of outcome, and the long-term functional status of patients with a diagnosis of primary chest wall sarcoma who undergo chest wall resection and reconstruction.</p><p><strong>Methods: </strong>We analyzed a prospectively maintained database, including all patients operated on between 2008 and 2021. The primary outcome measures were overall and disease-free survival and analyses were employed to determine the risk factors for poor survival and recurrence.</p><p><strong>Results: </strong>One hundred thirty-nine patients were included, 55% were men. The majority (96%) had an R0 resection and 75.1% had no postoperative complications up to 30 days postprocedure; median length of hospital stay was 7 days (range, 6-10 days). Median overall and disease-free survival was 58.8 and 53.6 months, respectively. For those alive, at long-term follow-up, 80% had a Medical Research Council dyspnea score of 0 and Karnofsky index >80%. Survival and mortality rates were better in chondrosarcomas compared with nonchondromatous sarcomas (P < .05). Previous history of radiotherapy, previous history of cancer, the type of sarcoma (Ewing's or soft tissue), the need for adjuvant treatment and tumor grade were significant predictors of mortality and recurrence on univariate testing. Extended resection, a higher number of ribs removed, and the incidence of postoperative complications were significantly associated with a worse postoperative Medical Research Council dyspnea score.</p><p><strong>Conclusions: </strong>Careful patient selection and multidisciplinary decision making is crucial. This leads to clear resection margins, good overall, and disease-free survival and good functional outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331323","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":"Do nonfatal events during the first 5 years after coronary artery bypass surgery influence 10 year outcomes?","authors":"Rodolfo V Rocha, Terrence M Yau, Anna Chu, Douglas S Lee, Maral Ouzounian, Vivek Rao","doi":"10.1016/j.jtcvs.2024.09.034","DOIUrl":"10.1016/j.jtcvs.2024.09.034","url":null,"abstract":"<p><strong>Objective: </strong>Few have examined the influence of early adverse events after coronary artery bypass grafting (CABG) on long-term survival. We sought to determine if the occurrence of nonfatal major adverse cardiac and cerebrovascular events (MACCE) during the first 5 years after CABG influences survival and adverse events at 10 years.</p><p><strong>Methods: </strong>All patients who underwent isolated CABG from 1990 to 2014 at a single center in Ontario, Canada, were included. Primary end point was all-cause mortality. The secondary end point of interest was MACCE, a composite of mortality, nonfatal myocardial infarction, stroke, and repeat revascularization.</p><p><strong>Results: </strong>A total of 20,444 cases of elective primary isolated CABG were identified as being alive at 5 years, with 11% of patients developing nonfatal MACCE within the first 5 years after CABG (MACCE group) and the remaining 89% were alive without a MACCE event at 5 years (non-MACCE group). Following propensity score matching, 2167 patient-pairs were formed. Among the MACCE group, 972 out of 2167 (44.9%) developed a myocardial infarction, 519 out of 2167 (24.0%) had a stroke, and 946 out of 2167 (43.7%) required a repeat revascularization within the first 5 years after CABG. Non-MACCE was associated with better overall survival (hazard ratio, 1.42; 95% CI, 1.25-1.63; P < .01) and freedom from MACCE (hazard ratio, 1.61; 95% CI, 1.45-1.79; P < .01) up to 10 years after CABG compared with MACCE cases.</p><p><strong>Conclusions: </strong>Patients who experienced nonfatal MACCE during the first 5 years after CABG experienced worse survival and more MACCE at 10 years. Prevention of major adverse events during the first 5 years after surgical revascularization may be an important strategy to improve late outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331331","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 blood type and body size on successful bridging to heart transplantation using intra-aortic balloon pump or surgically implanted microaxial left ventricular assist device.","authors":"Taylor Nordan, Mohamed Keshk, Amy Hackmann, Michael M Givertz, Mandeep R Mehra, Mark J Cunningham, Akinobu Itoh","doi":"10.1016/j.jtcvs.2024.09.028","DOIUrl":"10.1016/j.jtcvs.2024.09.028","url":null,"abstract":"<p><strong>Objective: </strong>Waitlist time for United Network for Organ Sharing Status 2 heart transplant candidates has steadily increased. We compared a bridging strategy using either the Impella 5.0/5.5 (\"Impella\") or intra-aortic balloon pump with a durable left ventricular assist device in patients with blood type O stratified by body habitus.</p><p><strong>Methods: </strong>The United Network for Organ Sharing registry was queried for adults listed for de novo heart transplantation (without dialysis) supported by the Impella, an intra-aortic balloon pump, or the HeartMate 3 left ventricular assist device. The primary outcome was 1-year postlisting survival, defined as the sum of waitlist time and post-heart transplant survival time if the candidate underwent heart transplantation.</p><p><strong>Results: </strong>In total, 2942 candidates were included (Impella: 214; intra-aortic balloon pump: 1326; HeartMate 3: 1402). Listing with the Impella or intra-aortic balloon pump was associated with worse postlisting survival compared with the HeartMate 3 left ventricular assist device in type O candidates (Impella: hazard ratio, 2.90 [95% CI, 1.48-5.67], P = .002; intra-aortic balloon pump: hazard ratio, 2.42 [95% CI, 1.59-3.68], P < .001) but less so in non-type O candidates. Further analysis of type O candidates demonstrated that the Impella and intra-aortic balloon pump were associated with a lower risk of postlisting mortality among those with normal height (25-75th percentile) and nonobese (body mass index <30) (Impella: hazard ratio, 1.78 [95% CI, 0.61-5.18], P = .292; intra-aortic balloon pump: hazard ratio, 1.28 [95% CI, 0.67-2.45], P = .455); among those not of normal height and nonobese, the Impella and intra-aortic balloon pump were associated with an elevated risk of postlisting mortality (Impella: hazard ratio, 3.65 [95% CI, 1.68-7.95], P = .001; intra-aortic balloon pump: hazard ratio, 3.01 [95% CI, 1.95-4.67], P < .001).</p><p><strong>Conclusions: </strong>Blood type O candidates listed with the Impella or intra-aortic balloon pump are at increased risk of postlisting mortality compared with a durable left ventricular assist device in the current organ allocation era. These effects are diminished among those with normal height and body habitus.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331342","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 the grade and jet-flow direction of residual aortic regurgitation after valve-sparing root replacement.","authors":"Hongsun Kim, Ok Jeong Lee, Jun Ho Lee, Yun Jin Kim, Su Ryeun Chung, Taek Kyu Park, Duk-Kyung Kim, Pyo Won Park, Kiick Sung","doi":"10.1016/j.jtcvs.2024.09.033","DOIUrl":"10.1016/j.jtcvs.2024.09.033","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of the grade and jet direction of residual aortic regurgitation (rAR) after valve-sparing root replacement (VSRR).</p><p><strong>Methods: </strong>The study enrolled 248 adult patients who underwent VSRR between 1995 and 2021. The patients were divided into groups based on the postoperative rAR. Patients with rAR were further categorized according to rAR grade and jet direction. The primary endpoint was the development of aortic regurgitation of moderate or greater (≥moderate) severity and/or the need for valve replacement during the follow-up, analyzed by a multivariable competing risk analysis. The secondary endpoints included the occurrence of rAR and overall survival.</p><p><strong>Results: </strong>The median age of the patients was 36.5 years, and 79.8% had been diagnosed with connective tissue disease. After VSRR, 146 patients did not present with rAR; however, 102 had rAR (77 with minimal central, 18 with minimal eccentric, and 7 with mild rAR). The 5-year and 8-year incidence rates of the primary endpoint were 14.6% and 17.9%, respectively. rAR was a significant risk factor (P = .001), and eccentricity and mild rAR seemed to have important roles. The risk factors for rAR included dilated root, preoperative moderate regurgitation, and redo sternotomy. Overall survival was influenced only by age.</p><p><strong>Conclusions: </strong>rAR after VSRR operation could be a risk factor for AR progression. Minimal central rAR generally has a tolerable clinical course; however, patients with even minimal eccentric AR may develop AR progression, so active surveillance and timely management might be required. Furthermore, early VSRR can help reduce the rAR.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331336","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 enlargement of the neo-aortic root and aortic arch following arch reconstruction in hypoplastic left heart syndrome.","authors":"Carmen Lopez Leiva, Devin Chetan, Ankavipar Saprungruang, Chun-Po S Fan, Marisa Signorile, Olivier Villemain, Vitor C Guerra, Christopher Z Lam, Mike Seed, Christoph Haller, David J Barron, Osami Honjo, Shi-Joon Yoo","doi":"10.1016/j.jtcvs.2024.09.024","DOIUrl":"10.1016/j.jtcvs.2024.09.024","url":null,"abstract":"<p><strong>Background: </strong>Long-term enlargement of the aortic arch after aortic arch reconstruction in hypoplastic left heart syndrome is not well described.</p><p><strong>Methods: </strong>Aortic arch measurements for 50 patients with hypoplastic left heart syndrome who achieved Fontan completion were converted to Pediatric Heart Network z-scores. Dimensions were assessed using linear mixed models, and differences among time points were evaluated with F-tests. Sub-analysis was conducted comparing Norwood (n = 36) with hybrid (n = 14) strategies.</p><p><strong>Results: </strong>Median time to last imaging was 6.4 (interquartile range, 3.5-11.3) years. Before intervention, the main pulmonary artery was dilated, whereas the ascending aorta, transverse arch, and isthmus were hypoplastic. With aortic arch reconstruction, there were expected increases in all arch z-scores. The aortic arch continued to dilate after aortic arch reconstruction, reaching peak values at 7 months (neo-aortic complex: z = 6.9 [5.6-8.0]) or 12 months after stage I (ascending aorta: z = 6.1 [2.9-8.3]; transverse arch: z = 4.7 [3.0-5.9]). After peak values, there was a gradual decline in z-scores with most components still at least mildly dilated at 16 years (neo-aortic complex: z = 3.2 [3.1-3.9], ascending aorta: z = 3.9 [3.3-4.2]; transverse arch: z = 3.1 [2.5-3.7]) with abrupt caliber change at the isthmus: z = -0.8 (-1.1 to -0.3). Norwood and hybrid strategies showed similar enlargement profiles after 7 months of age.</p><p><strong>Conclusions: </strong>Neo-aortic root and aortic arch in hypoplastic left heart syndrome are enlarged early after aortic arch reconstruction and continue to enlarge out of proportion to normal controls until 12 months of age, with gradual decline in enlargement up to adolescence. Further work should focus on modifiable surgical factors that may prove important to optimize arch growth and geometry.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331337","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":"Evaluating ChatGPT as a patient resource for frequently asked questions about lung cancer surgery-a pilot study.","authors":"Dana Ferrari-Light, Robert E Merritt, Desmond D'Souza, Mark K Ferguson, Sebron Harrison, Maria Lucia Madariaga, Benjamin E Lee, Susan D Moffatt-Bruce, Peter J Kneuertz","doi":"10.1016/j.jtcvs.2024.09.030","DOIUrl":"10.1016/j.jtcvs.2024.09.030","url":null,"abstract":"<p><strong>Objective: </strong>Chat-based artificial intelligence programs like ChatGPT are reimagining how patients seek information. This study aims to evaluate the quality and accuracy of ChatGPT-generated answers to common patient questions about lung cancer surgery.</p><p><strong>Methods: </strong>A 30-question survey of patient questions about lung cancer surgery was posed to ChatGPT in July 2023. The ChatGPT-generated responses were presented to 9 thoracic surgeons at 4 academic institutions who rated the quality of the answer on a 5-point Likert scale. They also evaluated if the response contained any inaccuracies and were prompted to submit free text comments. Responses were analyzed in aggregate.</p><p><strong>Results: </strong>For ChatGPT-generated answers, the average quality ranged from 3.1 to 4.2 of 5.0, indicating they were generally \"good\" or \"very good.\" No answer received a unanimous 1-star (poor quality) or 5-star (excellent quality) score. Minor inaccuracies were found by at least 1 surgeon in 100% of the answers, and major inaccuracies were found in 36.6%. Regarding ChatGPT, 66.7% of surgeons thought it was an accurate source of information for patients. However, only 55.6% thought they were comparable with answers given by experienced thoracic surgeons, and only 44.4% would recommend it to their patients. Common criticisms of ChatGPT-generated answers included lengthiness, lack of specificity regarding surgical care, and lack of references.</p><p><strong>Conclusions: </strong>Chat-based artificial intelligence programs have potential to become a useful information tool for patients with lung cancer surgery. However, the quality and accuracy of ChatGPT-generated answers need improvement before thoracic surgeons would consider this method as a primary education source for patients.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331333","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":"Elective root replacement increases the risk of type B dissection in patients with Marfan syndrome.","authors":"Ryan Thomas, Arjune S Dhanekula, Peter Byers, Rachel Flodin, Scott DeRoo, Sherene Shalhub, Christopher R Burke","doi":"10.1016/j.jtcvs.2024.09.027","DOIUrl":"10.1016/j.jtcvs.2024.09.027","url":null,"abstract":"<p><strong>Objective: </strong>Marfan syndrome is a genetic disorder with increased risk of aortic dissection. Currently, type A aortic dissection risk is mitigated by aortic root replacement with Dacron. It is unclear if root replacement increases the risk of distal aortic disease given the noncompliant nature of Dacron.</p><p><strong>Methods: </strong>All adult patients with a diagnosis of Marfan syndrome at a single academic center, excluding those with history of dissection or concomitant arch repair, were studied (n = 322). Student t test or Wilcoxon Mann-Whitney test was used for continuous variables; chi-square or Fisher exact test was used for categorical variables. Propensity matching used age, sex, hypertension, race, body mass index, family history of Marfan syndrome, and genetic mutational class. Differences in freedom from type B aortic dissection were determined using the log-rank test.</p><p><strong>Results: </strong>A total of 124 patients underwent root replacement compared with 198 patients with no prior aortic surgery. Median follow-up time was 9.90 years. Male sex, weight, and hypertension prevalence were higher in the root replacement group (P < .05). Distribution of fibrillin-1 mutations was homogenous (P > .9). Type B aortic dissection frequency in the root replacement group was higher (21% [n = 20] vs 4.2% [n = 4], P < .001). Aortic-related mortality was higher in the root replacement group (11% [n = 14] vs 3.5% [n = 7], P < .01). Distal aortic intervention frequency was higher in the root replacement group (P = .009).</p><p><strong>Conclusions: </strong>Patients with Marfan syndrome who undergo elective aortic root replacement appear to have a higher incidence of subsequent type B aortic dissection, independent of other risk factors. Careful consideration must be made to the management of the distal aorta in patients with Marfan syndrome who undergo root replacement.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331332","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}