The Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Comparing 3-Year Survival and Readmissions between HeartMate 3 and Heart Transplant as Primary Treatment for Advanced Heart Failure","authors":"Michael Kirschner, Veli K. Topkara, Jocelyn Sun, Paul Kurlansky, Yuji Kaku, Yoshifumi Naka, Melana Yuzefpolskaya, Paolo C. Colombo, Gabriel Sayer, Nir Uriel, Koji Takeda","doi":"10.1016/j.jtcvs.2023.12.019","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.019","url":null,"abstract":"<h3>Objective</h3><p>Our objective was to compare 3-year survival and readmissions of patients who received HeartMate 3 (HM3) left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure.</p><h3>Methods</h3><p>We retrospectively analyzed 381 adult patients who received HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT patients with prior LVAD were excluded and HM3 patients were censored at time of transplant. Cohorts were propensity score-matched (PSM) to reduce confounding variables. Primary outcome was 3-year survival. Secondary outcome was mean cumulative, all-cause, unplanned readmission.</p><h3>Results</h3><p>Cohorts consisted of 185 (49%) HM3 patients and 196 (51%) OHT patients, with 104 PSM patients in each group. After PSM, there was no statistical difference in 3-year survival (HM3 83.7% vs. OHT 87.0%, P = 0.91; RR = 1.00, 95% CI = 0.45-2.20). In unmatched cohorts, patients ages 18-49 had comparable survival with HM3 as with OHT (96.9% vs 95.9%, N = 91, P = 1.00; RR = 0.92, 95% CI = [0.09-9.78]); patients ages 50+ had similar with HM3, despite an 8.9% difference (75.0% vs 83.9%, N = 290, P = 0.60; RR = 1.51, 95% CI = [0.85-2.68]). Mean cumulative readmissions at 3-years was higher in the HM3 cohort (3.89 vs. 2.05, P &lt; 0.001).</p><h3>Conclusion</h3><p>This exploratory analysis suggests that for similar patients HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure, but may result in more readmissions.</p>","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139051559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age Is Superior to Aortopathy Phenotype as a Predictor of Aortic Mechanics in Patients with Bicuspid Valve","authors":"Matthew A. Thompson, Benjamin Kramer, Samar A. Tarraf, Emily Vianna, Callan Gillespie, Emidio Germano, Brett Gentle, Frank Cikach, Ashley M. Lowry, Amol Pande, Eugene Blackstone, Jennifer Hargrave, Robb Colbrunn, Chiara Bellini, Eric E. Roselli","doi":"10.1016/j.jtcvs.2023.12.018","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.018","url":null,"abstract":"<h3>Objectives</h3><p>Bicuspid aortic valve (BAV) aortopathy is defined by three phenotypes—root, ascending, and diffuse—based on region of maximal aortic dilation. We sought to determine the association between aortic mechanical behavior and aortopathy phenotype versus other clinical variables.</p><h3>Methods</h3><p>From 08/01/2016 to 03/01/2022, 375 aortic specimens were collected from 105 patients undergoing elective ascending aortic aneurysm repair for BAV aortopathy. Planar biaxial data (191 specimens) informed constitutive descriptors of the arterial wall that were combined with <em>in vivo</em> geometry and hemodynamics to predict stiffness, stress, and energy density under physiologic loads. Uniaxial testing (184 specimens) evaluated failure stretch and failure Cauchy stress. Boosting regression was implemented to model the association between clinical variables and mechanical metrics.</p><h3>Results</h3><p>There were no significant differences in mechanical metrics between the root phenotype (N=33, 31%) and ascending/diffuse phenotypes (N=72, 69%). Biaxial testing demonstrated older age was associated with increased circumferential stiffness, decreased stress, and decreased energy density. On uniaxial testing, longitudinally versus circumferentially oriented specimens failed at significantly lower Cauchy stress (50th [15th, 85th percentiles]: 1.0 [0.7, 1.6] MPa vs. 1.9 [1.3, 3.1] MPa; <em>P</em>&lt;0.001). Age was associated with decreased failure stretch and stress. Elongated ascending aortas were also associated with decreased failure stress.</p><h3>Conclusions</h3><p>Aortic mechanical function under physiologic and failure conditions in BAV aortopathy is robustly associated with age and poorly associated with aortopathy phenotype. Data suggesting that the root phenotype of BAV aortopathy portends worse outcomes are unlikely to be related to aberrant, phenotype-specific tissue mechanics.</p>","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139054360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion to: Long-term implantable ventricular assist device support in children","authors":"","doi":"10.1016/j.jtcvs.2023.11.042","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.042","url":null,"abstract":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion to: Impact of preoperative aortic regurgitation on long-term autograft durability and dilatation in children and adolescents undergoing the Ross procedure","authors":"","doi":"10.1016/j.jtcvs.2023.11.036","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.036","url":null,"abstract":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion to: Should mitral valve replacement age guidelines be lowered due to better bioprosthetic mitral valve durability?","authors":"","doi":"10.1016/j.jtcvs.2023.11.033","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.033","url":null,"abstract":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139029601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Determines Outcomes in Multivalve Reoperations? Effect of Patient and Surgical Complexity","authors":"Joshua E. Insler, Aaron E. Tipton, Faisal G. Bakaeen, Jules J. Bakhos, Penny L. Houghtaling, Eugene H. Blackstone, Eric E. Roselli, Edward G. Soltesz, Michael Z. Tong, Shinya Unai, Kenneth McCurry, Patrick Vargo, Kevin Hodges, Nicholas G. Smedira, Gösta B. Pettersson, Aaron Weiss, Marijan Koprivanac, Haytham Elgharably, A. Marc Gillinov, Lars G. Svensson","doi":"10.1016/j.jtcvs.2023.12.005","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.005","url":null,"abstract":"<h3>Objective</h3><p>Patient characteristics, risks, and outcomes associated with reoperative multivalve cardiac surgery are poorly characterized. Effect of patient variables and surgical components of each reoperation were evaluated with regard to operative mortality.</p><h3>Methods</h3><p>From January 2008 to January 2022, 2324 patients with previous cardiac surgery underwent 2352 reoperations involving repair or replacement of multiple cardiac valves at Cleveland Clinic. Mean age was 66±14 years. Number of surgical components representing surgical complexity (valve procedures, aortic surgery, coronary artery bypass grafting [CABG], and atrial fibrillation procedures) ranged from 2 to 6. Random forest for imbalanced data was used to identify risk factors for operative mortality.</p><h3>Results</h3><p>Surgery was elective in 1327 (56%), urgent in 1006 (43%), and emergency in 19 (0.8%). First-time reoperations were performed in 1796 (76%) and 556 (24%) had 2 or more previous operations. Isolated multivalve operations comprised 54% (1265) of cases; 1087 incorporated additional surgical components. Two valves were operated on in 80% (1889) of cases, 3 in 20% (461), and 4 in 0.09% (2). Operative mortality was 4.2% (98/2352), with 1.7% (12/704) for elective, isolated multivalve reoperations. For each added surgical component, operative mortality incrementally increased, from 2.4% for 2 components (24/1009) to 17% for ≥5 (5/30). Predictors of operative mortality included CABG, surgical urgency, cardiac, renal dysfunction, peripheral artery disease, New York Heart Association functional class, and anemia.</p><h3>Conclusions</h3><p>Elective, isolated reoperative multivalve surgery can be performed with low mortality. Surgical complexity coupled with key physiologic factors can be used to inform surgical risk and decision-making.</p>","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138568368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion to: The severity of chronic obstructive pulmonary disease is associated with adverse outcomes after open thoracoabdominal aortic aneurysm repair","authors":"","doi":"10.1016/j.jtcvs.2023.10.053","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.10.053","url":null,"abstract":"Abstract not available","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138568503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multifocal Disease Progression and Subsequent Intervention in Patients with Actin Alpha-2 Variants; A Single Center Experience","authors":"Jean-Luc A. Maigrot, Patrick R. Vargo, Benjamin Kramer, Christina Rigelsky, Joanna Ghobrial, Kenneth Zahka, Hani Najm, Eric E. Roselli","doi":"10.1016/j.jtcvs.2023.11.052","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.052","url":null,"abstract":"<h3>Objectives</h3><p>Describe patient characteristics and indications for surgical intervention, reoperation, and outcomes in patients with actin alpha-2 (ACTA2) variants.</p><h3>Methods</h3><p>Single center retrospective cohort study with prospective follow-up was performed for 38 patients with an ACTA2 variant.</p><h3>Results</h3><p>From 1999–2020, twenty-six (70%) patients underwent surgery, 11 remain under surveillance (mean follow-up 7.5 ± 5 years). Median age at index operation was 42 (range 10-69) years, with 4 pediatric cases. Thoracic aortic aneurysm was present in 19 (73%) patients (mean adult max diameter 5.2 ± 0.8 cm, pediatric z-score 10.7 ± 5.4). Aortic dissection was present in 13 (50%) patients, with 4 (15%) having Type A dissection. Operations included replacement of the aortic root in 16 (17%), ascending aorta in 20 (77%), and aortic arch in 14 (54%) patients. Four (15%) patients had coronary artery disease (CAD), and 2 (7.7%) underwent concomitant coronary artery bypass grafting. There was no operative mortality, stroke, re-operation for bleeding, or dialysis-dependent renal failure; One (3.8%) patient developed acute on chronic kidney injury. Three patients (12%) required prolonged ventilation. Eleven (42%) patients underwent 26 reoperations, median time 45 (range 4-147) months, including 5 open thoracoabdominal aneurysm repairs.</p><h3>Conclusions</h3><p>Patients with ACTA2 variants frequently develop aortic aneurysm and are at risk of aortic dissection and CAD. However, age at diagnosis and symptoms at presentation are highly variable. Multiple operations are often required for disease management, particularly after dissection. Close monitoring and timely intervention are important in mitigating disease progression and improving outcomes.</p>","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138548616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National utilization, trends, and lung transplant outcomes of static vs. portable ex vivo lung perfusion platforms.","authors":"A. Zhou, J. Ruck, A. Casillan, Emily L. Larson, Benjamin L. Shou, J. Ha, Pali D. Shah, Christian A. Merlo, Errol L. Bush","doi":"10.1016/j.jtcvs.2023.12.015","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.12.015","url":null,"abstract":"","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139016416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discussion to: Digital spatial profiling to predict recurrence in grade 3 stage I lung adenocarcinoma.","authors":"","doi":"10.1016/j.jtcvs.2023.11.039","DOIUrl":"https://doi.org/10.1016/j.jtcvs.2023.11.039","url":null,"abstract":"","PeriodicalId":501609,"journal":{"name":"The Journal of Thoracic and Cardiovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}