Annals of Thoracic Surgery最新文献

{"title":"Surgical versus Transcatheter Aortic Valve Replacement in Patients 65 Years of Age and Older.","authors":"Stanley Wolfe, Vikrant Jagadeesan, Lawrence Wei, J W Hayanga, Dhaval Chauhan, R Tyler Evans, Christopher Mascio, J Scott Rankin, Ramesh Daggubati, Vinay Badhwar, J Hunter Mehaffey","doi":"10.1016/j.athoracsur.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.02.003","url":null,"abstract":"<p><strong>Background: </strong>Approval of transcatheter aortic valve replacement (TAVR) for all risk profiles has extended TAVR use in patients not otherwise examined in clinical trials. We sought to evaluate contemporary real-world outcomes of surgical aortic valve replacement (SAVR) vs TAVR in Medicare beneficiaries by risk strata.</p><p><strong>Methods: </strong>Using the United States Centers for Medicare Services database, all patients aged 65-85 undergoing isolated first-time SAVR (n=34,215) or TAVR (n=124,897) were evaluated (2018-2022). Predicted patient risk accounting for comorbidities simulating Society of Thoracic Surgeons predicted risk of surgical mortality, but including frailty, were stratified by Low (<4%, n=36,297 TAVR, n=14,693 SAVR), Intermediate (4-8%, n=44,026 TAVR, n=9,693 SAVR), or High (>8%, n=44,574 TAVR, n=9,841 SAVR). Doubly robust risk-adjustment with inverse probability weighting and multilevel regression with competing-risk time-to-event analyses compared outcomes.</p><p><strong>Results: </strong>SAVR was associated with higher risk-adjusted in-hospital mortality, acute kidney injury, and bleeding but lower pacemaker rate compared to TAVR across all risk strata (all p<0.05). Longitudinal 5-year analysis highlighted that, compared to TAVR, SAVR was associated with superior freedom from composite death, stroke, or valve reintervention in low and intermediate risk patients (HR 0.85, p=0.044, and HR 0.86, p=0.039, respectively) as well as lower overall readmission for stroke in low (HR 0.72, p=0.038) and intermediate (HR 0.78, p=0.042) risk patients.</p><p><strong>Conclusions: </strong>In low and intermediate risk Medicare beneficiaries, SAVR was associated with higher in-hospital mortality but superior 5-year longitudinal freedom from death, stroke, or valve reintervention compared to TAVR. These data may further enhance heart team decision-making and patient counseling.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524856","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":"Apical Access Management in Transapical Transcatheter Mitral Valve Replacement.","authors":"Tillmann Kerbel, Mirjam G Wild, Michaela M Hell, Harald Herkner, Liliane Zillner, Elmar W Kuhn, Tanja Rudolph, Thomas Walther, Lenard Conradi, Andreas Zierer, Francesco Maisano, Marco Russo, Fabrizio Rosati, Andrea Colli, Miguel Piñón, David Reineke, Gaby Aphram, Christophe Dubois, Jörg Hausleiter, Ralph Stephan von Bardeleben, Martin Andreas","doi":"10.1016/j.athoracsur.2025.01.035","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.035","url":null,"abstract":"<p><strong>Background: </strong>The role of the surgical technique and anatomy in transapical mitral valve replacement (TA-TMVR) are scarcely investigated.</p><p><strong>Methods: </strong>Computed tomography scans, surgical reports and planning slides of 127 patients undergoing TA-TMVR with the Tendyne valve system at 15 centers, participating at a European observational study, were retrospectively analyzed and compared between patients with (cohort A) and without (cohort B) apical access complications (AAC).</p><p><strong>Results: </strong>A total of 8 (6.3%) AAC were recorded, of which 7/8 were observed in the first 10 patients of the respective center. Patients with AAC showed a trend to a thinner myocardium at the target access compared to those with regular access (median 4.4 vs. 6.1mm, p=0.086). Technical difficulties along with AAC were reflected by a significant longer procedural time (median 180 vs. 123min, p=0.011), higher rates of circulation support (50% vs. 0%, p<0.001), valve retrieval (38% vs. 3%, p=0.005) and bailout full sternotomy (13% vs. 0%, p=0.063). AAC were related with an intraprocedural mortality and in-hospital mortality rate of 25% (vs. 0%, p=0.010) and 50% (vs. 7%, p=0.003), respectively. Totally, 8 of 12 in-hospital deaths were attributed to AAC and/or sepsis. AAC significantly increased the risk for 30-day (adjusted OR 19.5, CI 2.19-178.3, p=0.008) and in-hospital mortality (adjusted HR 9.00, CI 1.95-41.42, p=0.005).</p><p><strong>Conclusions: </strong>Access complications in TA-TMVR are relatively rare but associated with poor short-term outcome. Focus on the apical myocardium within the screening process and specific surgical training might avoid AAC and improve outcome.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524855","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 Association between Residual Lesion Score and Long-Term Outcomes of Congenital Cardiac Operations.","authors":"Teerapong Tocharoenchok, Kok Hooi Yap, Brigitte Mueller, Chun-Po Steve Fan, David J Barron, Osami Honjo","doi":"10.1016/j.athoracsur.2025.01.034","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.034","url":null,"abstract":"<p><strong>Background: </strong>To investigate the impact of residual lesion score (RLS) on the long-term outcomes of 5 common congenital heart operations.</p><p><strong>Methods: </strong>All infants who underwent definitive surgery for complete atrioventricular septal defect (AVSD), tetralogy of Fallot (TOF), dextro-transposition of the great arteries (d-TGA), single ventricle (Norwood procedure), and coarctation with ventricular septal defect (CoA/VSD) between 2000 and 2012 who survived until discharge were studied. RLS scores (1 - no/trivial, 2 - minor, 3 - major or in-hospital reinterventions/reoperations for such lesions) were assigned based on post-repair clinical and echocardiographic evaluation. The time to events was summarized using the Kaplan-Meier survival method and competing risk models.</p><p><strong>Results: </strong>1027 patients were included (213 AVSDs, 358 TOFs, 308 d-TGAs, 127 single ventricles, and 21 CoA/VSDs) with a median follow-up time of 15 years (IQR 11-18.4 years). Overall, 227 patients (22.1%) had RLS of 1, 556 patients (54.1%) had RLS of 2, and 244 patients (23.8%) had RLS of 3. Freedom from late death/transplantation was 93.7% at 15 years. RLS was not associated with late death/transplantation. Male sex, TOF and ASO had the lowest risk for late death/transplantation. Late reintervention/reoperations were present in 14.5% at 15 years. Younger age, TOF/PS repair, ASO, RLS of 3 (HR 2.02, CI 1.17-3.51, p=0.012), intraoperative surgical revision, and in-hospital reintervention/reoperation associated with late reintervention/reoperation.</p><p><strong>Conclusions: </strong>The RLS does not predict late mortality but predicts late reintervention/reoperation after congenital cardiac repair and can be used to target at-risk patients for follow-up.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477030","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 Role of NLP and AI Tools in Mitigating Workforce Shortages in Healthcare.","authors":"James R Headrick, Mitchell J Parker, Ashley D Miller","doi":"10.1016/j.athoracsur.2025.01.033","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.033","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473331","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":"Outcomes of 230 Patients Undergoing Surgical Repair of Anomalous Aortic Origin of a Coronary Artery.","authors":"Richard D Mainwaring, Michael Ma, Shiraz Maskatia, Ed Petrossian, Olaf Reinhartz, James Lee, Frank L Hanley","doi":"10.1016/j.athoracsur.2025.01.029","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.029","url":null,"abstract":"<p><strong>Background: </strong>Anomalous aortic origin of a coronary artery (AAOCA) is being identified with increasing regularity and may be associated with myocardial ischemia and/or sudden death. There is an on-going controversy regarding which patients should have medical treatment, which should undergo surgical treatment, and what are the optimal surgical techniques to achieve lasting success.</p><p><strong>Methods: </strong>This was a retrospective review of 230 patients who underwent surgical repair of AAOCA at a single institution. Median age at surgery was 17 years. 130 had pre-operative symptoms prompting their referral for surgery including with sudden death. An additional 32 patients had associated congenital heart defects. 29% were asymptomatic. 187 had an anomalous right coronary whereas 43 had an anomalous left coronary. 192 had an intramural course while 38 did not including 13 with an intraconal course.</p><p><strong>Results: </strong>86 patients underwent an unroofing procedure, 123 underwent coronary reimplantation, 13 had repair of their intraconal left main, and 8 had other procedures. There were no early or late deaths with a median follow-up of 4 years. Six patients (2.6%) have required re-operations for recurrent symptoms and/or ischemia. Three of the six had anatomic narrowing of the coronary artery and the other three had an undiagnosed myocardial bridge. Five re-operations (5.8%) were in the unroofing cohort while 0 were in the reimplantation group.</p><p><strong>Conclusions: </strong>Surgical repair of AAOCA can be performed with extremely low mortality and low incidence of re-operation. Our current preference is to perform coronary reimplantation as this mitigates some pitfalls of the unroofing procedure.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473325","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":"Goal-directed Perfusion Strategy During Pediatric Cardiac Operation: Further Detail to Enhance Its Clinical Applicability.","authors":"Feng Long, Ronghua Zhou","doi":"10.1016/j.athoracsur.2025.01.031","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.031","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473320","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":"Sorting Out the Pieces of Fragmented Lung Cancer Care.","authors":"Juan M Farina, Jonathan D'Cunha","doi":"10.1016/j.athoracsur.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.030","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473327","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":"Enhancing Graft Patency in Coronary Artery Bypass Grafting: Fluid Mechanics, Anastomotic Techniques, and Flow Dynamics.","authors":"Yasunari Hayashi, Toshiaki Ito","doi":"10.1016/j.athoracsur.2025.01.032","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.032","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473315","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":"Editor's Choice","authors":"","doi":"10.1016/S0003-4975(25)00022-0","DOIUrl":"10.1016/S0003-4975(25)00022-0","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 3","pages":"Page A8"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429364","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":"Society Board","authors":"","doi":"10.1016/S0003-4975(25)00021-9","DOIUrl":"10.1016/S0003-4975(25)00021-9","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 3","pages":"Page A7"},"PeriodicalIF":3.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143429363","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}