Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Invest in the Future","authors":"","doi":"10.1016/S0022-5223(24)01194-2","DOIUrl":"10.1016/S0022-5223(24)01194-2","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Page 683"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129848","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":"Adult Articles in AATS Journals","authors":"","doi":"10.1016/S0022-5223(24)01160-7","DOIUrl":"10.1016/S0022-5223(24)01160-7","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Page e13"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143130105","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":"Navigating the future of pediatric cardiovascular surgery: Insights and innovation powered by Chat Generative Pre-Trained Transformer (ChatGPT).","authors":"Rittal Mehta, Justus G Reitz, Alyssia Venna, Arif Selcuk, Bishakha Dhamala, Jennifer Klein, Christine Sawda, Mitchell Haverty, Can Yerebakan, Aybala Tongut, Manan Desai, Yves d'Udekem","doi":"10.1016/j.jtcvs.2025.01.022","DOIUrl":"10.1016/j.jtcvs.2025.01.022","url":null,"abstract":"<p><strong>Introduction: </strong>Interdisciplinary consultations are essential to decision-making for patients with congenital heart disease. The integration of artificial intelligence (AI) and natural language processing into medical practice is rapidly accelerating, opening new avenues to diagnosis and treatment. The main objective of this study was to consult the AI-trained model Chat Generative Pre-Trained Transformer (ChatGPT) regarding cases discussed during a cardiovascular surgery conference (CSC) at a single tertiary center and compare the ChatGPT suggestions with CSC expert consensus results.</p><p><strong>Methods: </strong>In total, 37 cases discussed at a single CSC were retrospectively identified. Clinical information comprised deidentified data from the last electrocardiogram, echocardiogram, intensive care unit progress note (or cardiology clinic note if outpatient), as well as a patient summary. The diagnosis was removed from the summary and possible treatment options were deleted from all notes. ChatGPT (version 4.0) was asked to summarize the case, identify diagnoses, and recommend surgical procedures and timing of surgery. The responses of ChatGPT were compared with the results of the CSC.</p><p><strong>Results: </strong>Of the 37 cases uploaded to ChatGPT, 45.9% (n = 17) were considered to be less complex cases, with only 1 treatment option, and 54.1% (n = 20) were considered more complex, with several treatment options. ChatGPT correctly provided a detailed and systematically written summary for each case within 10 to 15 seconds. ChatGPT correctly identified diagnoses for approximately 94.5% (n = 35) cases. The surgical intervention plan matched the group decision for approximately 40.5% (n = 15) cases; however, it differed in 27% cases. In 23 of 37 cases, timing of surgery was the same between CSC group and ChatGPT. Overall, the match between ChatGPT responses and CSC decisions for diagnosis was 94.5%, surgical intervention was 40.5%, and timing of surgery was 62.2%. However, within complex cases, we have 25% agreement for surgical intervention and 67% for timing of surgery.</p><p><strong>Conclusions: </strong>ChatGPT can be used as an augmentative tool for surgical conferences to systematically summarize large amounts of patient data from electronic health records and clinical notes in seconds. In addition, our study points out the potential of ChatGPT as an AI-based decision support tool in surgery, particularly for less-complex cases. The discrepancy, particularly in complex cases, emphasizes on the need for caution when using ChatGPT in decision-making for the complex cases in pediatric cardiovascular surgery. There is little doubt that the public will soon use this comparative tool.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081765","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":"Significance of isolated postoperative atrial fibrillation in thoracic aortic aneurysm repair","authors":"Megan M. Chung BA ,&nbsp;Cheryl Pan BA ,&nbsp;Hideyuki Hayashi MD ,&nbsp;Viswajit Kandula MD ,&nbsp;Yanling Zhao MS ,&nbsp;Dov Levine MD ,&nbsp;Patra Childress MD ,&nbsp;Lauren Sutherland MD ,&nbsp;Syed T. Raza MD, MA ,&nbsp;Paul Kurlansky MD ,&nbsp;Craig R. Smith MD ,&nbsp;Hiroo Takayama MD, PhD","doi":"10.1016/j.jtcvs.2023.12.023","DOIUrl":"10.1016/j.jtcvs.2023.12.023","url":null,"abstract":"<div><h3>Objective</h3><div>Although postoperative atrial fibrillation<span><span> has been shown to be associated with worse survival after thoracic aortic surgery, its effect on outcomes independently from other </span>postoperative complications is not well understood.</span></div></div><div><h3>Methods</h3><div><span>This is a single-center retrospective study of patients who underwent open thoracic aortic aneurysm repair between March 2005 and March 2021. Postoperative atrial fibrillation was defined as new-onset atrial fibrillation that developed during the index hospital stay. Patients with preoperative atrial fibrillation were excluded. Postoperative major complications included </span>reoperation<span><span><span> for bleeding, respiratory failure, </span>acute renal failure, and stroke. Variables associated with postoperative atrial fibrillation were analyzed with multivariable regression. Survival of patients without major complications was compared between patients without atrial fibrillation and patients with postoperative atrial fibrillation after </span>propensity score matching for baseline and intraoperative characteristics.</span></div></div><div><h3>Results</h3><div>Of 1454 patients, 520 (35.8%) were observed to have postoperative atrial fibrillation. Patients with postoperative atrial fibrillation had a higher rate of postoperative major complications than those without atrial fibrillation (20.2% vs 12.2%, <em>P &lt; .</em>001). Ten-year survival was 82.0% in patients with postoperative atrial fibrillation and 87.0% in patients without atrial fibrillation (<em>P = .</em>008). In the cohort of patients without complications, 10-year survival was similar between patients with and without postoperative atrial fibrillation after propensity score matching (83.6% vs 83.8%, <em>P = .</em>75).</div></div><div><h3>Conclusions</h3><div>Postoperative atrial fibrillation is common after open proximal thoracic aortic aneurysm<span> repair. Although development of major postoperative complications is associated with postoperative atrial fibrillation and decreased long-term survival, isolated postoperative atrial fibrillation does not appear to influence long-term survival.</span></div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 617-626.e7"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139375969","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":"Optimized strategy to improve the outcomes of acute type A aortic dissection with malperfusion syndrome","authors":"Shuangkun Chen MD ,&nbsp;Hua Peng MD ,&nbsp;Hui Zhuang MD ,&nbsp;Juxiang Wang MD ,&nbsp;Pianpian Yan MD ,&nbsp;Weiqun Zhang MD ,&nbsp;Weiliang Zheng BS ,&nbsp;Mingyu Li PhD ,&nbsp;Xijie Wu MD, PhD","doi":"10.1016/j.jtcvs.2024.01.006","DOIUrl":"10.1016/j.jtcvs.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><div><span>The mortality of acute type A aortic dissection (ATAAD) with </span>malperfusion syndrome (MPS) is high. However, the management strategy remains controversial. We aimed to evaluate the strategy for MPS at our institution.</div></div><div><h3>Methods</h3><div>Among 724 patients with ATAAD, 167 patients with MPS were treated with immediate central repair (first stage) or an optimized strategy (second stage). In the second stage, the optimized strategy used was based on 6-hour threshold from symptom onset. For MPS with symptom onset within 6 hours, immediate central repair was performed, followed by endovascular reperfusion if malperfusion persisted. With symptom onset beyond 6 hours, individualized delayed central repair was performed. We compared outcomes between the first and second stages.</div></div><div><h3>Results</h3><div>The in-hospital mortality of ATAAD was significantly decreased when the optimized strategy was used (4.3% in the second stage vs 12.5% in the first stage; <em>P</em> &lt; .01). In the second stage, the in-hospital mortality for MPS was decreased (10.2% vs 33.9%; <em>P</em><span> &lt; .01). Moreover, the in-hospital mortality for MPS with symptom onset within 6 hours and beyond 6 hours decreased from 24% to 7.5% and from 41.2% to 11.8%, respectively. The operative mortality of MPS in the second stage was comparable to that in patients without MPS (4.0% vs 2.4%; </span><em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>The optimized strategy significantly improved the outcomes of MPS. The 6-hour threshold from symptom onset could be very useful in determining the timing of central repair. For patients with MPS symptom onset within 6 hours, immediate central repair is reasonable; for those with symptom onset beyond 6 hours, individualized delayed central repair should be considered.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 562-573.e2"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456432","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":"Robotic-assisted extended thymectomy for large resectable thymoma: 21 years’ experience","authors":"Luyu Huang MD ,&nbsp;Zhongmin Li MD ,&nbsp;Feng Li MD ,&nbsp;Hongbin Zhang MD ,&nbsp;Wenqiang Zhang MD ,&nbsp;Aron Elsner MD ,&nbsp;Julia Strauchmann MD ,&nbsp;Marco Nicolas Andreas MD ,&nbsp;Tomasz Dziodzio MD ,&nbsp;Aina Lask MD ,&nbsp;Jens Neudecker MD ,&nbsp;Mahmoud Ismail MD ,&nbsp;Daipeng Xie MD ,&nbsp;Haiyu Zhou MD, PhD ,&nbsp;Andreas Meisel MD, PhD ,&nbsp;Jens-C. Rueckert MD, PhD","doi":"10.1016/j.jtcvs.2024.08.005","DOIUrl":"10.1016/j.jtcvs.2024.08.005","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate the perioperative and midterm oncological outcomes of robotic-assisted thoracic surgery extended thymectomy for patients with large resectable thymomas compared with small thymomas.</div></div><div><h3>Methods</h3><div>This retrospective single-center study included 204 patients with thymomas who underwent robotic-assisted thoracic surgery extended thymectomy between January 2003 and February 2024. Patients were divided into 2 groups based on the thymoma size (5-cm threshold).</div></div><div><h3>Results</h3><div>The study comprised 114 patients (55.9%) in the small thymoma group and 90 patients (44.1%) in the large thymoma group. No significant differences were found between the groups regarding gender, age, proportion of elderly patients, or pathologic high-risk classifications. Apart from a longer operative time (<em>P =</em> .009) in the large thymoma group, no differences were observed between the 2 groups regarding surgical parameters and postoperative outcomes. No deaths occurred within 30 days in either group. During a median follow-up of 61.0 months (95% CI, 48.96-73.04), 4 patients experienced recurrence (1.96%). No significant differences in the 5-year overall survival (<em>P =</em> .25) or recurrence-free survival (<em>P</em> = .43) were observed between groups.</div></div><div><h3>Conclusions</h3><div>Robotic-assisted thoracic surgery extended thymectomy is technically feasible, safe, and effective for treating large resectable thymomas. Moreover, midterm outcomes for patients with completely resected large thymomas were comparable to those with small thymomas during a median follow-up period of up to 5 years.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 469-483.e10"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of macitentan in Fontan-palliated patients: 52-week randomized, placebo-controlled RUBATO Phase 3 trial and open-label extension","authors":"Paul Clift MD ,&nbsp;Felix Berger MD ,&nbsp;Lars Sondergaard MD, MDSc ,&nbsp;Petra Antonova MD ,&nbsp;Patrick Disney MD ,&nbsp;Jeremy Nicolarsen MD ,&nbsp;Jean-Benoît Thambo MD ,&nbsp;Lidia Tomkiewicz Pajak MD ,&nbsp;Jou-kou Wang MD ,&nbsp;Annette Schophuus Jensen MD, PhD ,&nbsp;Michela Efficace MSc ,&nbsp;Michael Friberg PhD ,&nbsp;Diana Haberle PharmD, PhD ,&nbsp;Verena Walter Diplom-Mathematikerin (FH) ,&nbsp;Yves d’Udekem MD","doi":"10.1016/j.jtcvs.2024.08.039","DOIUrl":"10.1016/j.jtcvs.2024.08.039","url":null,"abstract":"<div><h3>Objectives</h3><div>The efficacy and safety of macitentan, an endothelin receptor antagonist, were assessed in a 52-week, prospective, multicenter, double-blind, randomized, placebo-controlled, parallel-group study assessing the efficacy and safety of macitentan in Fontan-palliated adult and adolescent patients (RUBATO-DB) and an open-label extension trial (RUBATO-OL).</div></div><div><h3>Methods</h3><div>Patients aged 12 years and older with New York Heart Association functional class II or III underwent total cavopulmonary connection more than 1 year before screening and showed no signs of Fontan failure/clinical deterioration. In RUBATO-DB, the primary efficacy end point was change in peak oxygen consumption from baseline to week 16; secondary end points were change from baseline over 52 weeks in peak oxygen consumption and change in mean count/minute of daily physical activity via accelerometer from baseline to week 16. Safety was assessed throughout both studies.</div></div><div><h3>Results</h3><div>In RUBATO-DB, 137 patients were randomized to macitentan 10 mg (n = 68) or placebo (n = 69); 92.7% completed 52-week double-blind treatment. At week 16, mean ± SD change in peak oxygen consumption was −0.16 ± 2.86 versus −0.67 ± 2.66 mL/kg/minute with macitentan versus placebo (median unbiased treatment difference estimate, 0.62 mL/kg/minute [99% repeated CI, −0.62 to 1.85]; <em>P</em> = .19). No treatment effect was observed in either of the secondary end points. During RUBATO-DB, most common adverse events with macitentan were headache, nasopharyngitis, and pyrexia. Across RUBATO-DB and RUBATO-OL, most common adverse events were COVID-19, headache, and fatigue. RUBATO-OL was prematurely discontinued because RUBATO-DB did not meet its primary or secondary end point.</div></div><div><h3>Conclusions</h3><div>The primary end point of RUBATO-DB was not met; macitentan did not improve exercise capacity versus placebo in patients with Fontan palliation. Macitentan was generally well tolerated over long-term treatment.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 385-394.e5"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk and reward of surgical aortic valve replacement","authors":"Joseph E. Bavaria MD","doi":"10.1016/j.jtcvs.2024.01.028","DOIUrl":"10.1016/j.jtcvs.2024.01.028","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 595-598"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139566320","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":"Acute type A intramural hematoma: The less-deadly acute aortic syndrome?","authors":"Rana-Armaghan Ahmad BS ,&nbsp;Felix Orelaru MD ,&nbsp;Akul Arora BS ,&nbsp;Carol Ling MS ,&nbsp;Karen M. Kim MD ,&nbsp;Shinichi Fukuhara MD ,&nbsp;Himanshu Patel MD ,&nbsp;G. Michael Deeb MD ,&nbsp;Bo Yang MD, PhD","doi":"10.1016/j.jtcvs.2024.01.032","DOIUrl":"10.1016/j.jtcvs.2024.01.032","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the short- and midterm outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD).</div></div><div><h3>Methods</h3><div>From 1996 to February 2023, a total of 106 patients with acute type A IMH and 795 patients with classic ATAAD presented for open aortic repair at our institution. Data were obtained from the local Society of Thoracic Surgeons’ Data Warehouse and medical chart review.</div></div><div><h3>Results</h3><div>Compared with the classic ATAAD group, the IMH group was older (65 vs 59 years, <em>P</em> &lt; .001) and more likely to be female (45% vs 32%, <em>P</em><span> = .005), with fewer comorbidities such as severe aortic insufficiency (5.0% vs 25%, </span><em>P</em> &lt; .001), acute stroke (2.8% vs 8.3%, <em>P</em><span> = .05), acute renal failure (5.7% vs 13%, </span><em>P</em><span> = .04), and malperfusion syndrome (8.5% vs 26%, </span><em>P</em><span> &lt; .001) but more cardiac tamponade (18% vs 11%, </span><em>P</em><span> = .03). The IMH group had less aortic root replacement (15% vs 33%, </span><em>P</em> &lt; .001), zone 2 arch replacements (9.4% vs 18%, <em>P</em> = .02), and shorter crossclamp times (120 minutes vs 150 minutes, <em>P</em><span> &lt; .001). The operative mortality was significantly lower in the IMH group (0.9% vs 8.8%, </span><em>P</em> = .005) and a multivariable regression model showed IMH to be protective, odds ratio of 0.11, <em>P</em> = .03. The 10-year survival was similar between the 2 groups (65% vs 61%, <em>P</em> = .35). The hazard ratio of IMH for midterm mortality after surgery was 0.73, <em>P</em> = .12.</div></div><div><h3>Conclusions</h3><div>Acute type A IMH could be treated with emergency open aortic repair with excellent short- and midterm outcomes.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 552-561"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571399","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":"Evaluation of sex differences in the receipt of concomitant atrial fibrillation procedures during nonmitral cardiac surgery","authors":"Catherine M. Wagner MD ,&nbsp;Patricia F. Theurer MSN ,&nbsp;Melissa J. Clark MSN ,&nbsp;Chang He MS ,&nbsp;Carol Ling MS ,&nbsp;Edward Murphy MD ,&nbsp;James Martin MD ,&nbsp;Steven F. Bolling MD ,&nbsp;Donald S. Likosky PhD ,&nbsp;Michael P. Thompson PhD ,&nbsp;Francis D. Pagani MD, PhD ,&nbsp;Gorav Ailawadi MD, MBA ,&nbsp;Robert B. Hawkins MD, MSc","doi":"10.1016/j.jtcvs.2024.04.011","DOIUrl":"10.1016/j.jtcvs.2024.04.011","url":null,"abstract":"<div><h3>Objective</h3><div>Women are less likely to receive guideline-recommended cardiovascular care, but evaluation of sex-based disparities in cardiac surgical procedures is limited. Receipt of concomitant atrial fibrillation (AF) procedures during nonmitral cardiac surgery was compared by sex for patients with preoperative AF.</div></div><div><h3>Methods</h3><div>Patients with preoperative AF undergoing coronary artery bypass grafting<span><span> and/or aortic valve replacement at any of the 33 hospitals in Michigan from 2014 to 2022 were included. Patients with prior cardiac surgery, transcatheter AF procedure, or emergency/salvage status were excluded. Hierarchical </span>logistic regression identified predictors of concomitant AF procedures, account for hospital and surgeon as random effects.</span></div></div><div><h3>Results</h3><div>Of 5460 patients with preoperative AF undergoing nonmitral cardiac surgery, 24% (n = 1291) were women with a mean age of 71 years. Women were more likely to have paroxysmal (vs persistent) AF than men (80% vs 72%; <em>P</em> &lt; .001) and had a higher mean predicted risk of mortality (5% vs 3%; <em>P</em> &lt; .001). The unadjusted rate of concomitant AF procedure was 59% for women and 67% for men (<em>P</em> &lt; .001). After risk adjustment, women had 26% lower adjusted odds of concomitant AF procedure than men (adjusted odds ratio, 0.74; 95% CI, 0.64-0.86; <em>P</em> &lt; .001). Female sex was the risk factor associated with the lowest odds of concomitant AF procedure.</div></div><div><h3>Conclusions</h3><div>Women are less likely to receive guideline recommended concomitant AF procedure during nonmitral surgery. Identification of barriers to concomitant AF procedure in women may improve treatment of AF.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"169 2","pages":"Pages 627-634.e4"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866949","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}