Annals of Thoracic Surgery最新文献

{"title":"The Society of Thoracic Surgeons National Intermacs Database Risk Model for Durable Left Ventricular Assist Device Implantation.","authors":"Francis D Pagani, Brandon Singletary, Ryan Cantor, J Hunter Mehaffey, Aditi Nayak, Jeffrey Teuteberg, Palak Shah, Jennifer Cowger, J David Vega, Daniel Goldstein, Paul A Kurlansky, Josef Stehlik, Jeffrey Jacobs, David Shahian, Robert Habib, Todd F Dardas, James K Kirklin","doi":"10.1016/j.athoracsur.2024.11.039","DOIUrl":"10.1016/j.athoracsur.2024.11.039","url":null,"abstract":"<p><strong>Background: </strong>Statistical risk models for durable left ventricular assist device (LVAD) implantation inform candidate selection, quality improvement, and evaluation of provider performance. This study developed a 90-day mortality risk model using The Society of Thoracic Surgeons National Intermacs Database (STS Intermacs).</p><p><strong>Methods: </strong>STS Intermacs was queried for primary durable LVAD implants from January 2019 to September 2023. Multivariable logistic regression was used to derive a model based on preimplant risk factors by using derivation (2019-2021 implants) and validation (2022-2023 implants) cohorts. Model performance (derivation and validation cohorts) was assessed using C-statistics, Brier scores, and calibration plots. A refined model (all patients) was generated to calculate observed-to-expected (O/E; 95% CI) ratios for each center.</p><p><strong>Results: </strong>The study population consisted of 11,342 patients from 2019 to 2023 who were sequentially divided in time into derivation (n = 6775) and validation (n = 4567) cohorts. Ninety-day mortality was 8.0% (9.2% in the derivation cohort vs 7.4% in the validation cohort; P = .001). Logistic regression applied to derivation and validation cohorts produced similar discrimination (area under the curve [AUC], 0.714 [95% CI, 0.69-0.74]; and AUC, 0.707; [95% CI, 0.67-0.72], respectively) and calibration (Brier score, .08 vs .07), with overestimation of risk among patients with a predicted risk >0.4. The O/E analysis identified 22 (12.5%) centers with worse than expected mortality with a 95% CI >1.0 and 14 centers (8.0%) with better than expected mortality with a 95% CI <1.0 (all P < .05).</p><p><strong>Conclusions: </strong>The STS Intermacs risk model demonstrated satisfactory discrimination and calibration. This tool may be used to inform candidate selection, facilitate quality improvement, and assess provider performance.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047456","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":"Volume-Outcome Relationship of Norwood Procedures: Insights from the National Pediatric Cardiology-Quality Improvement Collaborative Database.","authors":"Michal Schäfer, Carol McFarland, Venugopal Amula, Dongngan Truong, Linda M Lambert, Eric R Griffiths, Aaron W Eckhauser, S Adil Husain, Reilly D Hobbs","doi":"10.1016/j.athoracsur.2025.01.007","DOIUrl":"10.1016/j.athoracsur.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>Prior investigations of the center-specific case volume on outcomes in hypoplastic left heart syndrome have conflicting results. This study utilized the National Pediatric Cardiology-Quality Improvement Collaborative registry to investigate the center volume-outcome relationship in patients after the Norwood procedure with consideration of preoperative high-risk features.</p><p><strong>Methods: </strong>Between 2016 and 2023, centers were categorized by Norwood procedure volume into low- (≤5 cases/y), medium- (6 to 10 cases/y), and high-volume centers (>10 cases/y). We compared preoperative high-risk features between the center volume categories and assessed survival outcomes, focusing on 30-day and 1-year mortality. We further compared short-term perioperative morbidity outcomes.</p><p><strong>Results: </strong>We analyzed 3397 patients from 69 institutions participating in the National Pediatric Cardiology-Quality Improvement Collaborative. Twenty-nine centers were classified as a low-, 20 as medium-, and 20 as high-volume centers. There was no difference in frequency of preoperative high-risk features among the center categories in the majority of considered variables. There was no association between the volume categories and 30-day mortality. Low-volume and medium-volume were associated with higher risk of 1-year mortality. This difference remained when adjusting for the presence of high-risk features (Low: odds ratio, 1.40 [95% CI, 1.03-1.60], P = .020; Medium: odds ratio, 1.28 [95% CI, 1.05-1.86], P = .025). Postoperative comorbidities were more frequent in low- and medium-volume centers, including the need for diagnostic and interventional catheterization.</p><p><strong>Conclusions: </strong>Patients undergoing Norwood procedure in low- and medium-volume centers have worse 1-year mortality. The outcome characteristics are potentiated when adjusted for high-risk features, with significantly higher survival and lower morbidity in patients treated in high-volume centers.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048175","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":"Transcatheter vs Surgical Aortic Valve Replacement in Medicare Beneficiaries With Aortic Stenosis and Coronary Artery Disease.","authors":"Vikrant Jagadeesan, J Hunter Mehaffey, Mohammed A Kawsara, Dhaval Chauhan, J W Awori Hayanga, Christopher E Mascio, J Scott Rankin, Ramesh Daggubati, Vinay Badhwar","doi":"10.1016/j.athoracsur.2024.12.016","DOIUrl":"10.1016/j.athoracsur.2024.12.016","url":null,"abstract":"<p><strong>Background: </strong>As percutaneous therapeutic options expand, the optimal management of severe aortic stenosis (AS) and concomitant coronary artery disease (CAD) is being questioned between coronary artery bypass grafting with surgical aortic valve replacement (CABG+SAVR) and percutaneous coronary intervention with transcatheter aortic valve replacement (PCI+TAVR). This study sought to compare perioperative and longitudinal risk-adjusted outcomes between patients undergoing CABG+SAVR and patients undergoing PCI+TAVR.</p><p><strong>Methods: </strong>Using the Centers for Medicare & Medicaid Services inpatient claims database, the study evaluated all patient aged 65 years and older with AS and CAD who were undergoing CABG+SAVR or PCI+TAVR (from 2018 to 2022). Comorbidities and frailty were accounted for using validated metrics with doubly robust risk adjustment using inverse probability weighting, multilevel regression, and competing-risk time to event analyses. The primary end point was a 5-year composite of stroke, myocardial infarction (MI), valve reintervention, or death.</p><p><strong>Results: </strong>A total of 37,822 patients formed the study cohort (PCI+TAVR, n = 17,413; CABG+SAVR, n = 20,409). Accounting for age, comorbidities, frailty, and number of vessels revascularized, PCI+TAVR was associated with lower procedural mortality (1.1% vs 3.6%; odds ratio [OR], 0.29; P <.001) but higher vascular complications (OR, 6.02; P <.001) and new permanent pacemaker (OR, 1.92; P <.001). However, the longitudinal 5-year primary end point favored CABG+SAVR (20.4% vs 14.2%; OR, 1.44, P <.001). Subgroup analyses demonstrated a benefit in the use of arterial conduit in CABG+;AVR in patients with single-vessel CAD.</p><p><strong>Conclusions: </strong>Among Medicare beneficiaries with severe AS and CAD, CABG+SAVR was associated with higher procedural mortality than PCI+TAVR but lower 5-year risk-adjusted stroke, MI, valve reintervention, and death.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047773","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":"Redo Surgical Aortic Valve Replacement vs Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Bioprosthetic Valves.","authors":"Jake Awtry, Thais Faggion Vinholo, Mansoo Cho, Philip Allen, Robert Semco, Sameer Hirji, Siobhan McGurk, Paige Newell, Tanujit Dey, Mark J Cunningham, Ashraf Sabe, Kim de la Cruz","doi":"10.1016/j.athoracsur.2025.01.006","DOIUrl":"10.1016/j.athoracsur.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is associated with improved perioperative safety compared with redo surgical aortic valve replacement (redo-SAVR), but long-term outcomes remain uncertain. We therefore compare long-term outcomes of ViV-TAVR and redo-SAVR.</p><p><strong>Methods: </strong>The study included 1:1 propensity score-matched Medicare beneficiaries with degenerated bioprosthetic valves admitted between September 29, 2011, and December 30, 2020, undergoing either redo-SAVR or ViV-TAVR. Exclusion criteria included endocarditis, other concomitant cardiac surgery, and aortic valve reintervention during the same admission. The primary outcome was 5-year survival. Composite secondary outcomes included major adverse cardiovascular events (30-day operative mortality, stroke, or acute myocardial infarction) and major valve event-free survival (congestive heart failure readmission, endocarditis, or aortic valve reintervention). Time-to-event analyses used Kaplan-Meier analysis and multivariable Cox proportional hazards modeling.</p><p><strong>Results: </strong>Overall, 4699 patients, including 1775 redo-SAVR and 2924 ViV-TAVR patients, were identified. Redo-SAVR patients were younger (median [interquartile range], 72 [68-77] years vs 79 [73-84] years) with less congestive heart failure (39.6% vs 68.8%) and prior coronary artery bypass grafting (17.9% vs 32.0%; all P < .05). In the propensity score-matched cohorts of 1256 patients each, redo-SAVR had higher major adverse cardiovascular events (17.4% vs 13.1%; P = .003) but better major valve event-free (71 [62-79] months vs 43 [38-47] months; P < .001) and 5-year (62.3% vs 46.7%; P < .001) survival. After stratification by Charlson comorbidity index, the long-term survival benefit persisted in patients of lower (67.6% vs 54.9%; P = .001) and medium or higher risk (55.1% vs 36.7%; P < .001).</p><p><strong>Conclusions: </strong>Redo-SAVR may have better long-term survival than ViV-TAVR despite greater perioperative morbidity. Clinical trial data are needed to fully inform clinical decision-making about degenerated bioprosthetic valve reintervention, particularly for patients with reasonable life expectancy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048768","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":"Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter vs Surgical Aortic Valve Replacement With Concomitant Valve Disease.","authors":"Robert B Hawkins, Barbara C S Hamilton, Devraj Sukul, G Michael Deeb, Gorav Ailawadi, Shinichi Fukuhara","doi":"10.1016/j.athoracsur.2025.01.005","DOIUrl":"10.1016/j.athoracsur.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>The cause of increased risk for reoperation after transcatheter aortic valve replacement (TAVR) vs prior surgical aortic valve replacement (SAVR) is poorly understood. This study evaluated the impact of concomitant mitral and tricuspid valve disease on associated risk of TAVR explantation.</p><p><strong>Methods: </strong>Patients undergoing aortic valve replacement after prior SAVR or TAVR were extracted from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2021). Patients were stratified by TAVR explantation status and presence of severe concomitant valve disease for analyses. Risk adjustment was performed by multivariable logistic regression. Interaction terms were used to evaluate differential risk of concomitant valve disease for TAVR explantation vs redo-SAVR.</p><p><strong>Results: </strong>Of 24,097 redo aortic valve replacement patients, 877 (3.6%) underwent TAVR explantation. TAVR explantation patients had higher rates of concomitant severe valve disease (17% vs 14%; P < .001). Patients with severe concomitant valve disease had worse operative mortality after TAVR explantation (26.2% vs 14.6%; P < .001) and redo-SAVR (12.3% vs 6.9%; p < .001). TAVR explantation was independently associated with higher mortality (adjusted odds ratio [OR_adj], 1.3 [1.0-1.6]; P = .030). Severe mitral regurgitation (OR_adj, 1.2 [1.0-1.6]; P = .017), mitral stenosis (OR_adj, 2.0 [1.5-2.7; P < .001), and tricuspid regurgitation (OR_adj, 1.6 [1.3-1.9]; P < .001) were all associated with mortality, although these factors were not associated with disproportionately higher risk during TAVR explantation (P > .05).</p><p><strong>Conclusions: </strong>TAVR explantation cases have a higher burden of severe concomitant valve disease than redo-SAVR cases. Heart teams should consider these findings when discussing initial procedure choices for patients with multivalve disease, given their extreme risk at time of TAVR explantation.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048763","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":"Anastomotic Leak After Esophagectomy: Analysis of the STS General Thoracic Surgery Database.","authors":"Andrea L Axtell, Clara Angeles, Daniel P McCarthy, James D Maloney, Glen E Leverson, Malcolm M DeCamp","doi":"10.1016/j.athoracsur.2024.12.019","DOIUrl":"10.1016/j.athoracsur.2024.12.019","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak after esophagectomy is a major cause of morbidity and mortality. We sought to identify the prevalence of anastomotic leak, stratified by operative approach and disease etiology, as well as risk factors for leak.</p><p><strong>Methods: </strong>A retrospective cohort analysis using The Society of Thoracic Surgeons General Thoracic Surgery Database was conducted on patients who underwent esophagectomy with gastric reconstruction between 2009 and 2021. Baseline characteristics and postoperative outcomes were compared between patients who did and did not develop an anastomotic leak. Multivariable mixed effects logistic regression models identified risk factors for leak.</p><p><strong>Results: </strong>Of 18,419 patients, 3416 (19%) developed an anastomotic leak. Patients who leaked had more comorbidities, including obesity and diabetes. There was no difference in leak based on disease etiology (P = .435.) Patients with anastomotic leak had increased 30-day mortality (7% vs 4%, P < .001), reoperation (58% vs 10%, P < .001), and longer lengths of stay (18 vs 10 days, P < .001). On multivariable analysis, obesity (odds ratio [OR], 1.27; 95% CI, 1.16-1.38; P < .001), diabetes (OR, 1.14; 95% CI, 1.04-1.25; P = .006), and smoking (OR, 1.26; 95% CI, 1.15-1.37; P < .001) were independently predictive of anastomotic leak. Compared with an open 2-field, a transhiatal (OR, 1.35; 95% CI, 1.17-1.55; P < .001) or 3-field esophagectomy (OR, 1.46; 95% CI, 1.25-1.70; P < .001) was more likely to leak. A robotic approach was associated with an increased risk of leak (OR, 1.28; 95% CI, 1.03-1.08; P < .001), however lost significance in a modern subgroup from 2018-2021.</p><p><strong>Conclusions: </strong>Obesity, diabetes, smoking, pulmonary hypertension, and a cervical anastomosis are risk factors for anastomotic leak regardless of disease etiology. These important clinical risk factors identify an opportunity for modifiable risk reduction with aggressive medical optimization perioperatively.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048699","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":"Lobectomy vs Sublobar Resection in The Society of Thoracic Surgeons Database: Importance of Patient Factors and Lymph Node Evaluation.","authors":"Gavitt A Woodard, Maria Grau-Sepulveda, Mark W Onaitis, Brooks V Udelsman, Elizabeth A David, Jeffrey P Jacobs, Andrzej S Kosinski, Justin D Blasberg, Daniel J Boffa","doi":"10.1016/j.athoracsur.2025.01.004","DOIUrl":"10.1016/j.athoracsur.2025.01.004","url":null,"abstract":"<p><strong>Background: </strong>Prospective randomized trials have demonstrated noninferior survival between sublobar resection and lobectomy in healthy patients with non-small cell lung cancer with tumors ≤2 cm. However, some patient attributes are not well represented in randomized trials, and uncertainty remains in the widespread applicability of randomized trial nodal dissection protocols.</p><p><strong>Methods: </strong>Patients with ≤2 cm, node-negative non-small cell lung cancer (cT1 N0) in The Society of Thoracic Surgeons prospective database were linked to Medicare survival data by using a probabilistic matching algorithm. Survival was assessed by propensity score-weighted Kaplan-Meier analysis.</p><p><strong>Results: </strong>Overall, 20,031 patients were identified, including 11,976 patients who underwent lobectomy, 2586 who underwent segmentectomy, and 5469 who underwent wedge resection. Fewer lymph nodes were sampled in the sublobar resection group (mean, 5.5 vs 12.8), and pathologic upstaging was less common (7.1% vs 14.2%). Overall survival after sublobar and lobar resection was similar within groups understudied in recent trials, including age ≥75 years (P = .07), forced expiratory volume in 1 second of 10% to 59% (P = .14), and Zubrod performance status 2 to 3 (P = .23). When sublobar resection was performed with inadequate nodal evaluation (<2 nodes removed), survival was inferior to survival after lobectomy (P < .001). Among patients with nodal upstaging, lobectomy was not associated with improved survival over sublobar resection (P = .42).</p><p><strong>Conclusions: </strong>The clinical trial finding that sublobar resections achieve survival similar to that seen with lobectomy in early-stage lung cancer appears to apply to older, less healthy patients in a real-world setting, provided adequate lymph node resection is performed. Performing a lobectomy in the setting of nodal upstaging does not obviously improve survival. Further study is warranted to clarify the role of sublobar resection in the general population.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048767","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":"Malperfusion in Patients With Acute Type A Aortic Dissection: A Nationwide Analysis.","authors":"Nicholas J Goel, John J Kelly, William L Patrick, Yu Zhao, Joseph E Bavaria, Maral Ouzounian, Anthony L Estrera, Hiroo Takayama, Edward P Chen, T Brett Reece, G Chad Hughes, Eric E Roselli, Karen M Kim, Himanshu J Patel, Michael E Bowdish, Jason S Sperling, Bradley G Leshnower, Ourania Preventza, William T Brinkman, Nimesh D Desai","doi":"10.1016/j.athoracsur.2025.01.002","DOIUrl":"10.1016/j.athoracsur.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>This study describes in detail the clinical burden of malperfusion associated with acute type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.</p><p><strong>Methods: </strong>All patients undergoing repair of ATAAD between 2017 and 2020 in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions on the basis of imaging or the surgeon's evaluation. Multivariable logistic regression was used to analyze the effect of patient and treatment factors on outcomes in patients with and without malperfusion.</p><p><strong>Results: </strong>A total of 9958 patients undergoing ATAAD repair were studied. Preoperative malperfusion occurred in 27.7% (2748 of 9958) of cases and most often involved the extremity (14.9%; 1484 of 9958), renal (10.2%), or cerebral (9.8%) vascular beds. Operative mortality was much greater among patients with malperfusion (26.8% vs 13.6%; P < .001). After adjustment, coronary malperfusion was associated with the highest odds of mortality (odds ratio, 2.28; 95% CI, 1.85-2.81; P < .001) followed by mesenteric malperfusion (odds ratio, 1.82; 95% CI, 1.45-2.28; P < .001). Cerebral malperfusion was not independently associated with significantly increased odds of mortality (odds ratio, 1.14; 95% CI, 0.94-1.38; P = .18). Partial arch replacement (zone 1 or zone 2) compared with ascending aorta or hemiarch replacement only showed a similar rate of mortality in patients with malperfusion (24.8% vs 26.9%; P = .99) and without malperfusion (11.6% vs 13.6%; P = .54).</p><p><strong>Conclusions: </strong>Preoperative malperfusion in ATAAD was common and associated with significant operative mortality, which varied according to the malperfused region. Partial aortic arch replacement, compared with ascending aorta or hemiarch replacement alone, was not associated with increased mortality.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030226","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":"Insurance-Based Disparities in Cardiac Allograft Vasculopathy Following Heart Transplantation Are Mediated by Care at High Volume Centers.","authors":"Sara Sakowitz, Syed Shahyan Bakhtiyar, Saad Mallick, Sara Pereira, Jennifer Nelson, Rushi Parikh, Robert Higgins, Richard Shemin, Peyman Benharash","doi":"10.1016/j.athoracsur.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).</p><p><strong>Methods: </strong>We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network. CAV was defined as any evidence of angiographic coronary disease. Institutional volume was computed, with hospitals in the highest quartile (≥19cases/year) categorized as High-Volume Centers. Patients were stratified by insurance into the Medicaid and Non-Medicaid cohorts. The study period was divided into the pre-Affordable Care Act (ACA; 2004-2013) and post-ACA eras (2014-2022).</p><p><strong>Results: </strong>Of 37,073 heart transplant recipients, 4,875(13%) were insured by Medicaid. The overall incidence of CAV was 31%. Following risk-adjustment, Medicaid insurance was linked with significantly greater likelihood of developing CAV over 5 years (Hazard Ratio[HR] 1.08, 95%Confidence Interval[CI] 1.01-1.16). Importantly, this effect seems to have emerged in the post-ACA era (Pre-ACA HR 1.07, CI 0.84-1.36; Post-ACA HR 1.11, CI 1.02-1.21). Furthermore, among patients at High-Volume Centers, Medicaid insurance was linked with similar CAV likelihood (HR 1.04, CI 0.95-1.14). Yet, considering those treated at non-High-Volume Centers, Medicaid was associated with significantly greater CAV hazard (HR 1.14, CI 1.03-1.26). Overall, Medicaid remained associated with inferior patient (HR 1.31, CI 1.21-1.42) and allograft survival at 5-years (HR 1.29, CI 1.19-1.39).</p><p><strong>Conclusions: </strong>Medicaid-insured recipients faced inferior survival and greater risk of CAV over 5-years. Our work encourages closer follow-up and treatment for vulnerable populations in the months and years post-transplantation.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048766","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":"Assessing Lung Cancer Screening Eligibility of Lung Cancer Patients in the Boston Lung Cancer Study: An Analysis of 7,186 Lung Cancer Cases.","authors":"Alexandra L Potter, Quiana Guo, Deepti Srinivasan, Margaret E Yang, Meghan McCarthy, Danny Wang, Jui Kothari, Andrea Shafer, David C Christiani, Chi-Fu Jeffrey Yang","doi":"10.1016/j.athoracsur.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the proportion of lung cancer patients who would have qualified for lung cancer screening under different eligibility criteria in the Boston Lung Cancer Study (BLCS).</p><p><strong>Methods: </strong>BLCS participants diagnosed with lung cancer from 1992-2024 were identified for analysis. The proportion of patients who would have qualified for screening under the 2021 U.S. Preventive Services Task Force (USPSTF) (age 50-80, >20-pack-years, <15 quit-years), 20-year duration (age 50-80, 20-year smoking duration, <15 quit-years), American Cancer Society (age 50-80, >20-pack-years), NCCN-category-A (age >50, >20-pack-years), and NCCN-category-AB (aged >50, >20 pack-years OR >20-year smoking duration) guidelines were evaluated. We also evaluated the proportion of patients with a smoking history ineligible for screening under the aforementioned guidelines who had a PLCOm2012 risk score > 1.0%.</p><p><strong>Results: </strong>Of 7,186 patients meeting inclusion criteria, 33.4% currently smoked, 52.1% formerly smoked, and 14.5% had never smoked. Among these patients, 46.1% met the USPSTF guideline, 48.9% met the 20-year duration guideline, 61.0% met the American Cancer Society guideline, 66.1% met the NCCN-category-A guideline, and 71.7% met the NCCN-category-AB guideline. While the PLCOm2012 1.0% risk threshold identified 52.2% of patients with a smoking history who were ineligible for screening under the USPSTF criteria, the PLCOm2012 1.0% risk threshold excluded the majority of patients with <20 pack-years.</p><p><strong>Conclusions: </strong>In this analysis of 7,186 lung cancer patients, only 46.1% would have met the USPSTF criteria. Including a smoking duration criterion and removing the 15-years-since-quitting criterion from the USPSTF guideline would increase the proportion of patients eligible for screening.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048655","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}