Annals of Thoracic Surgery最新文献

{"title":"Clarifying the Evidence for Early SAVR in Asymptomatic Severe Aortic Stenosis.","authors":"Yuanyan Sun, Yonggang Dai","doi":"10.1016/j.athoracsur.2026.07.051","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.051","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tension Is the Enemy.","authors":"Anthony L Estrera","doi":"10.1016/j.athoracsur.2026.08.008","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.008","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should Kindergarteners Have a Pectus Repair?","authors":"Charles B Huddleston, Corinne Tan","doi":"10.1016/j.athoracsur.2026.08.009","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.009","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriate Use of Mechanical Circulatory Support Registries.","authors":"Ahmet Bilgili, Matthew S Purlee, Michael S Shillingford, Giles J Peek, Mark Steven Bleiweis, Jeffrey Phillip Jacobs","doi":"10.1016/j.athoracsur.2026.08.007","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.007","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Results and Technique of Single-Port (SP) Robotic Thoracic Surgery for Pulmonary Resection and Thymectomy.","authors":"Nikolaos Pachos, Robert J Cerfolio, Costas Bizekis, Michael Zervos","doi":"10.1016/j.athoracsur.2026.07.049","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.049","url":null,"abstract":"<p><strong>Background: </strong>The new SP (Single-Port) robotic system is increasingly used for thoracic surgery.</p><p><strong>Methods: </strong>A retrospective analysis of consecutive patients who underwent extra-thoracic, single-incision surgery, using the SP robotic system between December 2024 and January 2026.</p><p><strong>Results: </strong>From September 2024 to January 2026, 82 patients (44 women) underwent SP robotic thoracic surgery. The median height was 165.1cm (5'5\"), median BMI was 26.6. Types of operations were: thymectomy (n=28), lobectomy (n=32), segmentectomy (n=17), and pulmonary wedge resection (n=5). Median operative time for thymectomy was 101 minutes and 137 minutes for lung resection. Median chest tube duration for thymectomy was 0 h and was 7.3 h in the 54 patients who underwent pulmonary resection. Median actual blood loss of 20cc (range 15 - 40). Median hospital length of stay was 1 day for all. Median lymph node count was 29 in the right chest and 23 in the left (median of 5 N2 and 3 N1 stations). All had R0 resections. The new SP robotic stapler, used in the last 38 patients, had no malfunctions. No patient experienced major complications (Clavien-Dindo grade > IIIa). There was no 30- or 90-day mortality and the readmission rate within 60 days was 1%.</p><p><strong>Conclusions: </strong>This initial experience, the largest report outside of South Korea, shows that robotic thoracic surgery using the da Vinci single-port robotic surgical system, with the new SP robotic stapler is feasible and safe for thymectomy and complex anatomic lung resections, including lobectomy and segmentectomy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late results of the Ross Procedure.","authors":"Tirone E David, Carolyn M David, Bana Samman, Kyle Runeckles, Gloria Ho, Maral Ouzounian","doi":"10.1016/j.athoracsur.2026.07.050","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.050","url":null,"abstract":"<p><strong>Background: </strong>Most studies on the Ross procedure describe outcomes during the first 2 decades. The present report describes the outcomes at 30 years.</p><p><strong>Methods: </strong>From 1990 to 2004, 212 consecutive patients with a median age of 34 years underwent the Ross procedure. Freestanding aortic root replacement was used in 108 patients, and aortic root inclusion in 104. Patients have been followed prospectively for a median of 26.6 years. Valve function was assessed by echocardiography at periodic intervals. Adverse events were assessed using appropriate statistical analyses.</p><p><strong>Results: </strong>Patients' 30-year survival was 79.4% (95% CI, 71.1%-85.6%), 9.1% lower than that of the Canadian general population matched for sex and age. Forty-seven (22%) patients required Ross-related reinterventions, totaling 64 surgical and 12 percutaneous procedures. Cumulative incidences at 30 years for any Ross-related reinterventions were 28.4% (95% CI - 21.8%, 37.1%), for pulmonary autograft reoperation was 19.1% (95% CI - 13.7%, 26.6%), and for pulmonary homograft was 17.1% (95% CI -1 1.9%, 24.7%). Dilated aortic annulus, older age, and freestanding aortic root replacement were associated with reoperation on the autograft by multivariable analysis. At 30 years, the cumulative incidence of autograft dysfunction (aortic insufficiency and stenosis) was 38.0% [95% CI 31.4%, 46.0%], and pulmonary homograft dysfunction was 62.6% (95% CI - 54.2%, 72.3%).</p><p><strong>Conclusions: </strong>The Ross procedure is a good aortic valve substitute for young adults, but it does not restore normal lifespan, and the function of both valves deteriorates over time, including the development of autograft valve stenosis.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention for Stable Multivessel Coronary Disease in the Current Era.","authors":"David DeFazio, Lawrence Wei, Dhaval Chauhan, Jeremiah W Hayanga, Christopher Mascio, Ramesh Daggubati, Vinay Badhwar, J Hunter Mehaffey","doi":"10.1016/j.athoracsur.2026.06.059","DOIUrl":"10.1016/j.athoracsur.2026.06.059","url":null,"abstract":"<p><strong>Background: </strong>Recent changes to society-specific guidelines for the management of stable coronary artery disease (CAD) have challenged decades of data comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). We sought to compare index and longitudinal outcomes in these populations using a large contemporary real-world cohort.</p><p><strong>Methods: </strong>Using the United States Centers for Medicare and Medicaid Services database, we evaluated longitudinal outcomes of all beneficiaries aged ≥65 years undergoing multivessel CABG (n = 105,729) vs multivessel PCI (n = 13,192) for stable CAD (2018-2023). A predicted risk of index CABG mortality model, inclusive of frailty, was fit to simulate The Society of Thoracic Surgeons mortality model (area under the curve, 0.807). Doubly robust risk adjustment was performed with multivariable time-to-event analyses conducted in matched groups.</p><p><strong>Results: </strong>Propensity score matching yielded well-balanced groups (n = 9206 per group) with a median age of 74 years, 71.2% men, and predicted mortality risk of 1.2%. Over the 6-year study period in this well-matched cohort, CABG was associated with superior longitudinal survival (hazard ratio [HR], 0.44; 95% CI, 0.40-0.49; P < .001) and freedom from myocardial infarction (HR, 0.40; 95% CI, 0.36-0.44; P < .001), coronary reintervention (HR, 0.10; 95% CI, 0.08-0.14; P < .001), and the composite outcome of myocardial infarction, coronary reintervention, or death (89.2% vs 71.1%; HR, 0.38; 95% CI, 0.35-0.41; P < .001).</p><p><strong>Conclusions: </strong>In Medicare beneficiaries with stable multivessel disease, CABG was associated with lower hospital mortality, superior longitudinal survival, and freedom from myocardial infarction and coronary reintervention. These contemporary real-world data support prior trials highlighting the benefits of CABG in stable multivessel CAD, urging a reevaluation of recent guidelines.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13378741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"When a measure becomes a target, it ceases to be a good measure.\"","authors":"Ralph S Mosca","doi":"10.1016/j.athoracsur.2026.08.006","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.006","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Robot Effect: How Surgical Approach Relates to Guideline-Directed Management of Concomitant Diseases During Mitral Valve Repair.","authors":"Miia Lehtinen, Daniel J Romary, Seokyung An, Jane Kruse, Abigail S Baldridge, Ravi Chowdhury, Kira Gerweck, Douglas R Johnston, Patrick M McCarthy, Kevin E Hodges","doi":"10.1016/j.athoracsur.2026.08.001","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.001","url":null,"abstract":"<p><strong>Background: </strong>Candidates for robotic-assisted mitral valve repair (R-MVr) sometimes have concomitant atrial fibrillation (AF) and/or tricuspid valve regurgitation (TR). We investigated the effect of concomitant AF and/or moderate or greater TR on choice between R-MVr and median sternotomy (MS-MVr) and the effect of surgical approach on guideline-directed management of AF and TR.</p><p><strong>Methods: </strong>From 2015-2024, patients in the STS Adult Cardiac Surgery Database who underwent MVr for degenerative mitral regurgitation with/without concomitant tricuspid valve repair (TVr), surgical ablation (SA), and/or left atrial appendage occlusion (LAAO) by either robotic or sternotomy approach were identified. Multivariable logistic regression was performed to assess our primary outcomes.</p><p><strong>Results: </strong>The study included 17,169 patients (8,203 MS-MVr, 8,966 R-MVr). Concomitant AF was present in 3,245 (18.9%) and moderate or greater TR in 2,565 (14.9%). Patients with AF (OR 0.51, 95% CI [0.45-0.58]), TR (OR 0.50 [0.43-0.58]) or both (OR 0.38 [0.31-0.47]) were less likely to receive R-MVr vs. MS-MVr. Compared to MS-MVr, patients undergoing R-MVr with AF less frequently had concomitant SA (OR 0.44 [0.35-0.55]) or LAAO (OR 0.40 [0.31-0.52]) and those with TR less frequently had TVr (OR 0.25 [0.19-0.32]). Operative outcomes were similar between MS-MVr and R-MVr with concomitant SA, LAAO, and/or TVr.</p><p><strong>Conclusions: </strong>Surgeons are more likely to perform MS-MVr than R-MVr for patients with AF and/or TR, while guideline-directed management of AF and TR are less common with R-MVr, demonstrating a complex relationship between concomitant conditions and surgical approach. Patients deserve a steadfast commitment to guideline directed care, irrespective of surgical approach.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Closing the Gap\" Longitudinal Analysis of Gender Differences in Cardiothoracic Surgery Training Operative Experiences.","authors":"Dena G Shehata, Gitu Degefa, Manuel Castillo-Angeles, Jennifer M Pan, Duykhanh Ceppa, Elliot L Servais, Stephen C Yang, John D Mitchell, Mariya Samoylova, Mara Antonoff, Ammara A Watkins","doi":"10.1016/j.athoracsur.2026.08.004","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.004","url":null,"abstract":"<p><strong>Background: </strong>Gender-based disparities in operative experience are reported in many surgical subspecialties; however, data in cardiothoracic surgery (CT) are limited. This study examined gender differences in operative experience among CT surgery trainees.</p><p><strong>Methods: </strong>A retrospective analysis of Accreditation Council for Graduate Medical Education (ACGME) case log data was performed for cardiothoracic surgery trainees graduating in 2016-2024 (excluding 2022), including integrated (I-6) and traditional pathways. Cumulative operative volumes were compared by gender across pathways, subspecialty tracks, and regions. Temporal trends were assessed, and multivariable linear regression evaluated the association between gender and operative volume after adjustment for training and program factors.</p><p><strong>Results: </strong>Case logs from 724 CT surgery trainees (76.5% men, 23.5% women) were analyzed. Mean operative volume was 851 ± 207 cases, with no difference by gender. Women were more likely to pursue the thoracic track (48.8% vs 38.1%, p=0.041), and women's representation increased over time (p=0.040). Operative volume increased across training years for all trainees (p<0.001), with similar trends by gender. No gender differences were observed in total, major, thoracic, or cardiac case volumes in subgroup or adjusted analyses; minor case volume showed a non-significant trend toward higher volume among women.</p><p><strong>Conclusions: </strong>Gender representation in cardiothoracic training is improving, with more women pursuing the thoracic track. Operative volumes are comparable by gender, with no differences in total case numbers. Future studies should assess operative autonomy and case complexity across genders.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}