Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"The intra-aortic balloon pump as a rescue device: Do we need to shift our strategy for cardiogenic shock rescue after cardiac surgery?","authors":"Parth B Patel, Anelechi Anyanwu, Caroline R Gross, David H Adams, Robin Varghese","doi":"10.1016/j.jtcvs.2024.09.029","DOIUrl":"10.1016/j.jtcvs.2024.09.029","url":null,"abstract":"<p><strong>Objective: </strong>The intra-aortic balloon pump (IABP) is widely used to rescue patients from complications following cardiac surgery. Given improvements in rescue strategies over the past decade, the appropriateness of IABP must be reexamined. This study assessed the risk factors, outcomes, and predictors of survival of rescue IABP placement.</p><p><strong>Methods: </strong>Patients receiving an isolated rescue IABP during or after cardiac surgery from 2012 to 2020 were studied. All adult patients undergoing cardiac surgery except transplantation and primary mechanical circulatory support (MCS) procedures were included.</p><p><strong>Results: </strong>Of 10,591 patients, 397 (3.7%) received a perioperative IABP, including 182 (45.8%) with rescue IABP placement. The indications for rescue IABP were postcardiotomy shock (n = 66; 36.3%), failure to wean off cardiopulmonary bypass (n = 58; 31.9%), myocardial ischemia (n = 30; 16.5%), cardiac arrest (n = 25; 13.7%), and ventricular arrhythmia (n = 3; 1.6%). The in-hospital failure to rescue rate was 17.6% (n = 32 of 182) with a 90-day survival of 80.8% and 1-year survival of 76.9%. The most common etiology of mortality was ongoing cardiogenic shock (61.9%; n = 26 of 42). IABP use for >4 days and cardiac arrest as an indication for IABP were risk factors for 1-year mortality (adjusted hazard ratio, 2.68 [95% confidence interval (CI), 1.31-5.50] and 2.69 [95% CI, 1.11-6.54], respectively).</p><p><strong>Conclusions: </strong>Rescue IABP following cardiac surgery is associated with increased early and 1-year mortality. Prolonged IABP use beyond 4 days or cardiac arrest as an indication portended a significantly worse prognosis. Rescue IABP may not be the optimal first-line temporary MCS for all patients, as the level of support provided might not match the severity of cardiogenic shock. Alternative MCS strategies should be considered early.</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":"142331343","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":"Postoperative Aortic Isthmus Size After Arch Reconstruction with Patch Augmentation Predicts Arch Reintervention.","authors":"Dominic P Recco, Shannen B Kizilski, Gianna J Dafflisio, Reena M Ghosh, Pakaparn Kittichokechai, Kimberlee Gauvreau, Breanna Piekarski, Ashwin Prakash, David M Hoganson","doi":"10.1016/j.jtcvs.2024.09.031","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.031","url":null,"abstract":"<p><strong>Objective: </strong>Reintervention rates after patch-augmented reconstruction for hypoplastic aortic arch remain moderately high. We analyzed mid-term outcomes of aortic arch reconstruction to define modifiable reintervention risk factors.</p><p><strong>Methods: </strong>Excluding Damus-Kaye-Stansel anastomoses and previous arch repair, 338 patients underwent arch reconstruction from 2000-2021 at median age 6d (IQR 4-13d) and weight 3.2kg (IQR 2.8-3.7kg). Surgical technique was patch augmentation with coarctectomy ± interdigitation in 269 (80%), isolated patch aortoplasty in 41 (12%), and other reconstruction in 28 (8%). Risk factors for reintervention were assessed using competing risk models.</p><p><strong>Results: </strong>At median follow-up of 3.9y (IQR 1.1-8.0y), 35 (10.4%) patients required reintervention (30 endovascular, 12 surgical, 7 both). Ten-year cumulative incidence of death/transplant and reintervention were 10% (95%CI 4-20%) and 13% (95%CI 8-20%). On univariate analysis, isolated patch aortoplasty (p=0.002), aortic homograft patch material (p=0.006), and postoperative aortic size z-score ≤-2 for each segment were associated with greater risk of reintervention: ascending aorta (p=0.006), proximal (p=0.001) and distal (p=0.005) transverse arch, and aortic isthmus (p<0.001). On multivariable analysis, aortic homograft (HR 6.29, 95%CI 1.94-20.5, p=0.002) and postoperative isthmus z-score ≤-2 (HR 10.5, 95%CI 5.15-21.5, p<0.001) remained significant. Patients with repaired isthmus z-score ≤-2 had 72.8% (95%CI 44.6-94.4%) cumulative incidence of reintervention at 10 years, versus 6.8% (95%CI 4.1-11.4%) in those with z-score >-2.</p><p><strong>Conclusions: </strong>Aortic undersizing during patch-augmented reconstruction of hypoplastic aortic arch results in over 10% rate of reintervention at mid-term follow-up. Achieving adequate postoperative arch size is critical for preventing reintervention, with aortic isthmus size being of utmost importance.</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":"142331338","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":"Gender Representation in Cardiothoracic Surgical Academia: A call to support women across the globe.","authors":"Cecilia Pompili, Rita Costa, Busra Cangut, Isabelle Opitz, Paula Ugalde Figueroa, Daniela Molena, Leah Backhus, Shanda Blackmon, Amy Fiedler, Jolanda Kluin, Julie Cleuziou, Franca Melfi, Stephanie Fuller, Douglas E Wood, Mara B Antonoff","doi":"10.1016/j.jtcvs.2024.09.032","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.09.032","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331334","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":"Protective effects of 10 °C preservation on donor lungs with lipopolysaccharide-induced acute lung injury.","authors":"Keiji Yamanashi, Aizhou Wang, Catherine A Bellissimo, Gabriel Siebiger, Paolo Oliveira, Yu Zhang, Juan Montagne, Guillermo Garza, Nadav Furie, Prodipto Pal, Mingyao Liu, Ewan C Goligher, Shaf Keshavjee, Marcelo Cypel","doi":"10.1016/j.jtcvs.2024.09.022","DOIUrl":"10.1016/j.jtcvs.2024.09.022","url":null,"abstract":"<p><strong>Objectives: </strong>Hypothermic lung preservation at 10 °C has been recently shown to enhance quality of healthy donor lungs during ischemia. This study aims to show generalizability of the 10 °C lung preservation using an endotoxin-induced lung injury with specific focus on the benefits of post-transplant lung function and mitochondrial preservation.</p><p><strong>Methods: </strong>Lipopolysaccharide (3 mg/kg) was injected intratracheally in rats to induce lung injury. Injured lungs were flushed with preservation solution and allocated to 3 groups (n = 6 each): minimum cold storage, 6-hour storage on ice (ice), and 6-hour storage at 10 °C (10 °C). Left lungs were transplanted and reperfused for 2 hours. After storage, lung tissue was used to evaluate the effects of hypothermic storage on the mitochondrial function: mitochondrial membrane potential was assessed by JC-1 staining; mitochondrial oxygen consumption was assessed using high-resolution respirometry.</p><p><strong>Results: </strong>Two hours after reperfusion, the oxygen tension/inspired oxygen fraction ratio from the graft was significantly greater in the 10 °C group than in the Ice group (P = .015), whereas the wet-to-dry weight ratio was significantly lower (P = .041). Levels of interleukin-8 in lung tissues were significantly lower in the 10 °C group than in the Ice group (P = .004). Mechanistically, we noted greater mitochondrial membrane potential and elevated state III respiration in the 10 °C group than in the Ice group (P = .015 and P = .002, respectively), implying higher metabolic activities may be maintained during 10 °C preservation.</p><p><strong>Conclusions: </strong>Favorable metabolism during 10 °C preservation prevented ischemia-induced mitochondrial damages in injured lungs, leading to better post-transplant outcomes.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331339","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":"Clinical effectiveness of genetic testing guidelines in patients with thoracic aortic aneurysms.","authors":"Ely Erez, Adrian R Acuna Higaki, Michela Cupo, Tuan Anh Phu, Shiv Verma, Roland Assi, Prashanth Vallabhajosyula","doi":"10.1016/j.jtcvs.2024.09.026","DOIUrl":"10.1016/j.jtcvs.2024.09.026","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the effectiveness of the current genetic testing guidelines for patients with thoracic aortic aneurysms.</p><p><strong>Methods: </strong>We evaluated genetic tests for thoracic aortic disease (TAD) from 2012 to 2023 in patients aged 18 and older with a thoracic aorta diameter greater than 4 cm. Mutation rates were compared by American College of Cardiology/American Heart Association testing criteria met by patients: age younger than 60 years, syndromic features of connective tissue diseases (CTDs), family history, or none. Results were classified as pathogenic, variants of uncertain significance (VUS), or negative. Genes tested were analyzed in 2 categories: primary (strongly associated with heritable diseases) or secondary (less strongly associated).</p><p><strong>Results: </strong>In total, 1034 patients were included: 42.4% aged younger than 60 years, 19.1% with syndromic features of CTD, 41.8% with family history, and 30.7% meeting no criteria. Overall, 3.97% had pathogenic mutations, and 27.27% had VUS. Mutation rates were greatest in patients with syndromic features of CTD (13.2%), followed by patients aged younger than 60 years (5.48%), with a family history (4.63%), and with no criteria met (2.21%). Primary genes had pathogenic mutation rates of 3.29% and VUS rates of 12.19%. Secondary genes had lower pathogenic rates (0.68%) but greater VUS (17.5%). Mutation rates in primary genes peaked at 22% in patients meeting all criteria, whereas those younger than 60 years without family history or syndromic features of CTD had the lowest rate (0.54%).</p><p><strong>Conclusions: </strong>Refining genetic testing guidelines to incorporate multiple patient criteria could enhance risk stratification and support informed decision-making in genetic testing for TAD. Limiting testing to genes strongly associated with TAD could lower VUS rates.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331324","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: While examining the means, let us not neglect the ends.","authors":"Daniel P Raymond","doi":"10.1016/j.jtcvs.2024.09.021","DOIUrl":"10.1016/j.jtcvs.2024.09.021","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142331326","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: Medium-term outcomes of concomitant aortic valve repair in patients with continuous-flow left ventricular assist device.","authors":"","doi":"10.1016/j.jtcvs.2024.07.052","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.07.052","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299694","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":"All compensation isn't equal: Gender disparities continue to exist for industry payments in Cardiothoracic Surgery.","authors":"Emily June Zolfaghari, Oluwaseun F Ayoade, Mara B Antonoff","doi":"10.1016/j.jtcvs.2024.08.046","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2024.08.046","url":null,"abstract":"","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299690","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":"Late follow-up for a randomized trial of surgical treatment of tricuspid valve regurgitation in patients undergoing left ventricular assist device implantation.","authors":"Michelle Mendiola Pla, Stuart D Russell, Carmelo A Milano, Yuting Chiang, Lillian Kang, Emily Poehlein, Cynthia L Green, Frank Benedetti, Han Billard, Benjamin S Bryner, Jacob N Schroder, Mani A Daneshmand, Alina Nicoara, Adam D DeVore, Chetan B Patel, Muath Bishawi","doi":"10.1016/j.jtcvs.2024.09.023","DOIUrl":"10.1016/j.jtcvs.2024.09.023","url":null,"abstract":"<p><strong>Background: </strong>We previously reported that concurrent tricuspid valve surgery (TVS) was not associated with a lower incidence of early right heart failure (RHF) in patients undergoing durable left ventricular assist device (LVAD) implantation. This follow-up analysis aimed to further define the clinical impact of concurrent TVS after 2 months of follow-up.</p><p><strong>Methods: </strong>Patients with moderate or severe tricuspid regurgitation (TR) on preoperative echocardiography (n = 71) were randomized to LVAD implantation either alone (no TVS group; n = 34) or with concurrent TVS (TVS group; n = 37). Randomization was stratified by preoperative right ventricular dysfunction. The patients were followed for at least 12 months after surgery. The incidence of RHF was determined by an adjudication committee using Interagency Registry for Mechanically Assisted Circulatory Support criteria. Functional studies and repeat echocardiography were performed at 12 months.</p><p><strong>Results: </strong>Demographics were similar in the 2 study arms. At 12 months, the rate of moderate or severe RHF was 50.0% in the no TVS arm versus 51.4% in the TVS arm. No patients developed RHF between 6 and 12 months following the procedure. Death from RHF was 5.4% in the TVS arm versus 8.8% in the no TVS arm. At 12 months, there was no significant difference in TR severity between the 2 arms, owing to improvement in TR severity in the no TVS arm. Cardiopulmonary exercise testing at 12+ months revealed no significant between-group difference in peak oxygen consumption.</p><p><strong>Conclusions: </strong>In patients with significant preimplantation TR, the severity of TR improved over time in the no TVS arm with LVAD implantation alone. By 12 months, there was no significant difference in TR severity between the 2 arms. This may account for the lack of difference in late clinical or functional parameters.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308963","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":"Dissecting the clinicopathologic, genomic, and prognostic significance of anaplastic lymphoma kinase rearrangement in resected lung adenocarcinoma.","authors":"Hang Cao, Wangyang Zhu, Huatao Tang, Chaoqiang Deng, Fangqiu Fu, Yuan Li, Yang Zhang, Haiquan Chen","doi":"10.1016/j.jtcvs.2024.09.020","DOIUrl":"10.1016/j.jtcvs.2024.09.020","url":null,"abstract":"<p><strong>Objectives: </strong>The ALINA trial introduced anaplastic lymphoma kinase (ALK) inhibitors in an early-stage context, generating notable interest. This study aims to investigate the characteristics and prognostic implications of ALK rearrangement in patients with resected lung adenocarcinoma (LUAD).</p><p><strong>Methods: </strong>We retrospectively evaluated resected LUAD cases with documented ALK status from 2008 to 2020. The association between ALK positivity and clinicopathologic characteristics, molecular profiles, and outcomes was explored.</p><p><strong>Results: </strong>Among 4944 cases, 238 (4.8%) were ALK-positive, correlating with younger age and nonsmokers. ALK positivity was also significantly associated with pure-solid nodules, spread through air spaces, and solid-predominant adenocarcinoma. ALK-positive tumors exhibited an overall low frequency of co-mutations (eg, TP53, STK11). ALK positivity was associated with inferior recurrence-free survival (RFS) in patients with stage I who did not receive adjuvant chemotherapy whereas it was associated with prolonged RFS in patients with stage II and III who received adjuvant chemotherapy. Notably, 6 patients treated with adjuvant ALK inhibitors experienced no recurrence or metastasis during the follow-up period. In addition, the administration of ALK inhibitors significantly improved postrecurrence survival in patients positive for ALK.</p><p><strong>Conclusions: </strong>ALK positivity was associated with specific aggressive pathologic features and inferior RFS in stage I LUAD. Patients positive for ALK seemed to benefit more from adjuvant chemotherapy. Active treatment with ALK inhibitors or chemotherapy should be considered for patients with ALK-positive LUAD, although further evidence is warranted to expand their utility in early-stage disease management.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299695","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}