Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Surgery for thymic malignancy and nonthymic malignancy incidence: A national longitudinal study","authors":"Samir Bouam MD, PhD ,&nbsp;Antonio Bobbio MD, PhD ,&nbsp;Lucia Parlati MD ,&nbsp;Stylianos Tzedakis MD ,&nbsp;Elisa Daffré MD ,&nbsp;Ludovic Fournel MD, PhD ,&nbsp;Nicolas Venissac MD, PhD ,&nbsp;Pierre E. Falcoz MD, PhD ,&nbsp;Vincent Mallet MD, PhD ,&nbsp;Marco Alifano MD, PhD","doi":"10.1016/j.jtcvs.2025.05.017","DOIUrl":"10.1016/j.jtcvs.2025.05.017","url":null,"abstract":"<div><h3>Objective</h3><div>Previous clinical series and registry analyses have identified a link between thymic malignancies and nonthymic malignancies observed concurrently or subsequent to a thymic malignancy diagnosis. The impact of surgery for thymic malignancies on the risk of subsequent nonthymic malignancies is controversial. We aimed to evaluate this impact in a nationwide setting.</div></div><div><h3>Methods</h3><div>Using the French National Discharge Database (2014-2023), we conducted a retrospective cohort study of adults diagnosed with a first thymic malignancy (International Classification of Diseases, 10th Revision code C37) recorded as the primary discharge diagnosis. Patients with nonthymic malignancies diagnosed before 2015 or within 6 months of thymic malignancy diagnosis were excluded. The primary outcome was nonthymic malignancies, with surgery for thymic malignancies as the main exposure. We measured nonthymic malignancies incidences across treatment groups in complete and propensity score–matched samples. Associations were estimated using time-dependent adjusted hazard ratios and odds ratios.</div></div><div><h3>Results</h3><div>Among 3611 patients with thymic malignancy, 2616 (72.4%) underwent surgery for thymic malignancies, either alone (n = 2114) or within a multimodality approach (n = 502). The incidence of nonthymic malignancies was 30.08 (95% CI, 26.21-33.96) and 53.50 (95% CI, 44.26-62.73) per 1000 person-years in patients with and without surgery for thymic malignancies, respectively (log <em>P &lt;</em> .001). In the complete sample, the adjusted hazard ratio of nonthymic malignancies after surgery for thymic malignancies was 0.85 (95% CI, 0.80-0.90; <em>P &lt;</em> .001). In matched samples, the adjusted odds ratio was 0.66 (95% CI, 0.52-0.83; <em>P &lt;</em> .001). Lung cancer showed the largest incidence reduction (adjusted hazard ratio, 0.79, 95% CI, 0.72-0.86; <em>P &lt;</em> .001).</div></div><div><h3>Conclusions</h3><div>Surgery for thymic malignancies was associated with a reduced incidence of nonthymic malignancies in patients with thymoma.</div></div>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":"170 4","pages":"Pages 969-975.e8"},"PeriodicalIF":4.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200699","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":"Interpretable Artificial Intelligence to Predict Preoperative Risk Factors for Failure to Rescue after Coronary Artery Bypass Grafting.","authors":"Rameshbabu Manyam, Pengfei Lou, Hong-Jui Shen, Zhanxu Liu, Yanqing Zhang, Xiao Hu, William Brent Keeling","doi":"10.1016/j.jtcvs.2025.09.039","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.039","url":null,"abstract":"<p><strong>Objective(s): </strong>Failure to rescue is a significant quality indicator for postoperative cardiothoracic care. We developed an interpretable artificial intelligence (AI) model to identify, interpret, and integrate patient risk factors to predict FTR after coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Adults who underwent isolated CABG in an academic health system from 2011 to 2022 were analyzed. FTR was defined as 30-day postoperative mortality after a stroke, renal failure, reoperation, or prolonged ventilation. The study evaluated 35 patient-specific preoperative variables using 'recursive feature elimination with cross-validation' algorithm and AI methods to determine optimal set of risk factors to predict FTR. SHapley Additive exPlanations were performed to visualize and interpret models.</p><p><strong>Results: </strong>A total of 9,974 patients were identified, and the overall FTR rate was 2.5% (n=249). FTR rates were 12.9% for stroke, 24.8% for renal failure, 11.4% for reoperation, and 11.6% for prolonged ventilation. The model produced the top 12 risk factors: age, albumin, bilirubin, body mass index, creatinine, ejection fraction, hematocrit, hemoglobin, hemoglobin a1c, model for end stage liver disease score, platelets, and white blood cell count. The Random Forest algorithm demonstrated good performance with an area under the precision-recall curve of 0.78.</p><p><strong>Conclusions: </strong>This study utilized AI algorithms to evaluate and interpret an optimal set of preoperative risk factors for FTR after CABG. The Random Forest model demonstrated good discrimination in identifying at-risk patients. The proposed framework can serve as proof-of-concept that can translate, with further research, into a real-time clinical decision support tool for at-risk patients. [247 words].</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214299","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 impacts of biological valve size on long-term outcomes of primary surgical aortic valve replacement for aortic stenosis.","authors":"Rieko Kutsuzawa, Satoshi Kainuma, Naonori Kawamoto, Kota Suzuki, Takashi Kakuta, Ayumi Ikuta, Kohei Tonai, Masaya Hirayama, Hironobu Sakurai, Shinichi Kurashima, Yuki Irie, Takahiro Sakamoto, Kenji Moriuchi, Masashi Amano, Atsushi Okada, Kensuke Takagi, Makoto Amaki, Hideaki Kanzaki, Takeshi Kitai, Chisato Izumi, Kazuhiro Yamamoto, Takashi Daimon, Satsuki Fukushima","doi":"10.1016/j.jtcvs.2025.09.035","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.035","url":null,"abstract":"<p><strong>Objectives: </strong>We clarified associations between biological valve sizes selected during primary surgical aortic valve replacement (SAVR) and its long-term outcomes.</p><p><strong>Methods: </strong>In total, 754 consecutive patients with aortic stenosis who underwent primary biological SAVR were classified into three groups based on valve size: 19-mm (n=246), 21-mm (n=262), and ≥23-mm (n=246). Severe prosthesis-patient mismatch (PPM) was defined as measured indexed effective orifice area ≤0.65 cm²/m² if body mass index (BMI) is <30 kg/m² and ≤0.55 cm²/m² if BMI is ≥30 kg/m². The mean observation period was 6.6±4.0 years (4996 patient-years).</p><p><strong>Results: </strong>Patients with 19-mm valve were older (19-mm: 74±7.8 years vs. 21-mm: 72±8.0 years vs. ≥23-mm: 69±10 years), predominantly female (91% vs. 55% vs. 13%), and had smaller body surface area (BSA) (1.39±0.12 m² vs. 1.53±0.15 m² vs. 1.67±0.16 m²). The incidence of post-SAVR severe PPM was 15%, 5.8%, and 5.0%, respectively (p< 0.001 for all). However, a mixed-effects model demonstrated that left ventricular (LV) mass index regressed equivalently (interaction effect=0.189). During follow-up, 142 (19%) mortalities and 41 (5.4%) aortic valve reinterventions (31 redo-SAVR and 10 valve-in-valve) were observed, without difference in 10-year all-cause mortality rate (21% vs. 33% vs. 27%, p=0.438). Fine-Gray regression model identified age at surgery (adjusted hazard ratio 0.4 per 10-year, p<0.001) and use of 19-mm valve (adjusted hazard ratio 4.0, p<0.001) as independent associates with aortic valve reinterventions.</p><p><strong>Conclusions: </strong>Despite a higher incidence of severe PPM and aortic reintervention after primary SAVR, use of a 19-mm biological valve can be justified for elderly patients with small BSA, as evidenced by equivalent long-term survival and LV mass regression to those with larger valves.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208449","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 Effective Orifice Area on Long-Term Survival in Bioprosthetic versus Mechanical Aortic Valves.","authors":"Sina Danesh, Vincy Tam, Aurora Lee, Tedy Sawma, Arman Arghami, John M Stulak, Philip Rowse, Kimberly Holst, Austin Todd, Kevin L Greason, Malakh Shrestha, Gabor Bagameri, Alberto Pochettino, Vuyisile T Nkomo, Sorin V Pislaru, Mackram F Eleid, Rajiv Gulati, Mayra Guerrero, Trevor Simard, Joseph A Dearani, Juan A Crestanello, Paul C Tang","doi":"10.1016/j.jtcvs.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.036","url":null,"abstract":"<p><strong>Introduction: </strong>We examined the potential impact of effective orifice area (EOA) and EOA index (EOAi) on survival between bioprosthetic and mechanical valves.</p><p><strong>Methods: </strong>We analyzed 3265 patients ≤75 years of age undergoing aortic valve replacement with or without coronary artery bypass grafting. EOA and EOAi were obtained from predischarge echocardiograms. Bootstrapped logistic regression and restricted cubic splines identified optimal survival cut-points for EOA and EOAi. Multivariable Cox proportional hazards models were fitted, and adjusted Kaplan-Meier survival curves were generated using the identified EOA cut-points.</p><p><strong>Results: </strong>The mechanical AVR group was younger (60 vs 69 years, P < 0.001). For mechanical and bioprosthetic AVR groups, respectively, the median EOA was (2.0 [1.6, 2.4] vs 2.1 [1.7, 2.6], P < 0.001) cm² and EOA index was (1.0 [0.8, 1.2] vs 1.1 [0.9, 1.3], P < 0.001) cm²/m². In patients with EOA >2 cm², long-term adjusted risk of mortality was higher in the bioprosthesis group compared to the mechanical group (HR:1.33, P=0.010). However, no significant difference was observed for those with EOA <2 cm² (HR:1.01, P=0.932). Similarly, for EOA index of >1.08 cm²/m², bioprosthesis group was associated with higher risk of long-term mortality (HR=1.29, P=0.040), while no significant association was found for those with an EOA index <1.08 cm²/m² (HR=1.05, P=0.621).</p><p><strong>Conclusions: </strong>In this cohort, there was a survival advantage of mechanical valves over bioprosthesis in larger valve sizes but not in patients with smaller EOA metrics.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208340","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":"Reply: Standardization for the unique heart; criteria for Fontan combined heart liver transplantation.","authors":"Grant Chappell, David L S Morales","doi":"10.1016/j.jtcvs.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.003","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180296","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":"Reply: Retrospective reality, prospective clarity.","authors":"Dan Jones, Nasser K Altorki","doi":"10.1016/j.jtcvs.2025.08.037","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.08.037","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151483","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":"Revisiting interpretability in artificial intelligence-based mitral valve risk models.","authors":"Can Xu, Xinyu Nie, Dongjin Wang","doi":"10.1016/j.jtcvs.2025.08.025","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.08.025","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139266","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":"Salvage Esophageal Reconstruction with Colonic Conduit: A Single Center 25-Year Experience.","authors":"John O Barron, Sadhvika Ramji, Nethra Jain, Andrew Conner, Andrew J Toth, Monisha Sudarshan, Daniel P Raymond, Usman Ahmad, Eugene H Blackstone, Eric Lamarre, Jeremy M Lipman, Sudish C Murthy, Siva Raja","doi":"10.1016/j.jtcvs.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.032","url":null,"abstract":"<p><strong>Objective: </strong>Colonic interposition restores alimentary continuity after esophagectomy when a gastric conduit is unavailable, but its use has been limited by concerns about morbidity and functional outcomes. Hence, we aimed to assess our 25-year institutional experience, including perioperative outcomes, a subset with patient-reported outcomes, and a contemporary cohort treated with middle-colic microvascular \"supercharging\" to augment perfusion.</p><p><strong>Methods: </strong>From 1/2000 to 6/2024, 99 patients underwent substernal colonic interposition. Endpoints included perioperative outcomes, post-operative symptoms, assessed by Cleveland Clinic Esophageal Questionnaire (CEQ), and overall survival estimated by Kaplan-Meier method.</p><p><strong>Results: </strong>Median age was 61 [47, 73] years. Forty-eight (48%) patients had esophageal cancer. An inferior mesenteric artery-based transverse colon segment was used in 83 (84%). Sixteen (16%) underwent supercharge. Thirty-day mortality was 5%. One patient with supercharge (6.3%, 68% CI 2.3%-16%), and 36 without (43%, CI 38%-49%), developed a cervical anastomotic leak (P = 0.004). Among 18 patients with CEQ, most symptoms were experienced never or rarely; weekly postprandial diarrhea and bloating were the most common symptoms, reported by 10 (56%) and 9 (50%) patients, respectively. Median CEQ T scores for each symptom domain ranged from 42-56 following colon interposition vs 40-47 following gastric conduit. Overall survival with and without esophageal cancer was 25% vs 66% at 10 years (P<.0001).</p><p><strong>Conclusions: </strong>Colonic interposition historically carried substantial short-term morbidity due to sequelae of frequent anastomotic leak. Present day, this can be mitigated with microvascular supercharge and a standardized multidisciplinary approach, warranting routine use. Contradicting conventional wisdom, long-term functional outcomes are similar to patients with a gastric conduit.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182109","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":"Single-Surgeon vs. Two-Surgeon Esophagectomy.","authors":"Aroub Alkaaki, Daniela Molena","doi":"10.1016/j.jtcvs.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.033","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182292","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":"Lung Transplant Outcomes After Implementation Of a Hospital-Based 10C Controlled Hypothermic Organ Preservation Unit.","authors":"Alexey Abramov, Joseph Costa, Jake Rosen, Richa Asija, Luke Benvenuto, Gabriela Magda, Lori Shah, Harpreet S Grewal, Angela DiMango, Hilary Robbins, Selim Arcasoy, Bryan P Stanifer, Philippe Lemaitre, Joshua Sonett, Frank D'Ovidio","doi":"10.1016/j.jtcvs.2025.09.024","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2025.09.024","url":null,"abstract":"<p><strong>Objective: </strong>Recent work suggests controlled hypothermic preservation (CHP) of lung donor allografts at 10^°C, when compared to standard ice cooler (IC) is associated with improved graft preservation. We hypothesized that clinical outcomes of lung transplant recipients (LTR) with lungs subjected to increased total preservation time (TPT) at 10^OC would be non-inferior.</p><p><strong>Methods: </strong>Retrospective single center cohort study of consecutive LTRs from Jan 2022 to July 2024, comparing outcomes of LTRs from donor organs exposed to 10^°C CHP versus standard IC. Lungs meeting criteria were procured, transported in IC and either implanted or transferred to 10^°C CHP unit until implantation.</p><p><strong>Results: </strong>263 consecutive LTR with 169 in 10^°C cohort and 94 in IC cohort were included. 251 patients (95%) survived to 90 days (161 patients [95%] 10C, 90 patients [96%] IC, p=0.8). Overall median TPT was 7hr 42min, significantly increased in 10^°C cohort (10hr 12min vs. 5hr, p <0.001). TPT range varied from 3hr 2 min to 22hr 49min. When comparing LTRs with TPT over 12hrs (10C Extended) vs. others in 10C cohort (10C Regular) vs. IC, there were no observed differences in PGD at 72hrs (p=0.2), median number of days of ECMO support (p=0.4), duration of mechanical ventilation (p=0.8). Overall survival at one year (n = 236, [90%], p=0.9) revealed no differences.</p><p><strong>Conclusions: </strong>Extension of total preservation time with a sustainable hospital-based controlled hypothermic preservation unit at 10^°C appears to be safe and non-inferior when compared to standard ice cooler preservation.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180252","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}