Annals of Thoracic Surgery最新文献

{"title":"Rerepair for Mitral Insufficiency","authors":"Akhil Rao BA ,&nbsp;Emily Shih MD ,&nbsp;Wilson Szeto MD ,&nbsp;Pavan Atluri MD ,&nbsp;Michael Acker MD ,&nbsp;Walter Clark Hargrove MD ,&nbsp;Lee Hafen MD ,&nbsp;Robert Smith MD ,&nbsp;Michael Ibrahim MD, PhD","doi":"10.1016/j.athoracsur.2024.05.022","DOIUrl":"10.1016/j.athoracsur.2024.05.022","url":null,"abstract":"<div><h3>Background</h3><div>Mitral valve repair provides superior outcomes to replacement for primary mitral regurgitation. Whether this is true after previous repair is unknown. This study presents the results of a strategy of rerepair for failed mitral valve repair. The study examined patients who were brought to the operating room for an intended mitral valve rerepair.</div></div><div><h3>Methods</h3><div>Study investigators reviewed the last decade of institutional mitral valve databases at The University of Pennsylvania (Philadelphia, PA) and Baylor Scott &amp; White The Heart Hospital - Plano (Plano, TX) and identified patients who underwent repeat mitral valve repair, in whom the index operation was mitral valve repair. The study analyzed their operative details and the clinical and echocardiographic outcomes.</div></div><div><h3>Results</h3><div>Between 2008 and 2021, 71 patients (aged 61.5 ±10.7 years; 20% female) underwent mitral valve reoperation at an mean of 6.24 ± 7.62 years after an index mitral repair. A total of 20% of patients presented with New York Heart Association functional class III or IV symptoms. At the index operation, 34 patients (47.9%) had repair through a right minithoracotomy. Fifteen patients (21.1%) required the reoperation within 1 year. There were 0 early and 8 late deaths. One patient who underwent mitral replacement instead of repair required reoperation for paravalvular leak during the follow-up period. Three patients required mitral valve replacement at an average of 2.28 ± 2.03 years after initial mitral valve rerepair.</div></div><div><h3>Conclusions</h3><div>Mitral rerepair can be performed with acceptable results at a valve reference center. Durability and functional advantages of this approach remain to be proven.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 370-376"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236426","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":"Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations","authors":"Salman Zaheer MD ,&nbsp;Sari D. Holmes PhD ,&nbsp;Emily Rodriguez BS ,&nbsp;Nolan M. Winicki MS ,&nbsp;Emily Larson BS ,&nbsp;Rachael Quinn PhD ,&nbsp;Gorav Ailawadi MD ,&nbsp;A. Marc Gillinov MD ,&nbsp;James S. Gammie MD","doi":"10.1016/j.athoracsur.2024.09.042","DOIUrl":"10.1016/j.athoracsur.2024.09.042","url":null,"abstract":"<div><h3>Background</h3><div>Conduction abnormalities requiring permanent pacemaker (PPM) implantation are common after tricuspid valve operations, although the incidence is variable. This study investigated contemporary rates of and risk factors for a PPM after tricuspid operations.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to identify patients with tricuspid repair or replacement from 2011 to 2020. Factors independently associated with the risk of a postoperative PPM during the index hospital admission were examined using multivariable logistic regression with a complete case approach. Annualized hospital and surgeon volumes were calculated.</div></div><div><h3>Results</h3><div>We identified 71,937 patients undergoing tricuspid operations. Median patient age was 66 years (interquartile range, 53-74 years), 56% (n = 40,590) were women, and the median ejection fraction was 0.56 (interquartile range, 0.48-0.60). Tricuspid operations were concomitant in 87% (n = 62,457), elective in 62% (n = 44,393), and included repair in 86% (n = 61,720). Overall postoperative incidence of a PPM was 15% (n = 10,857); 13% (n = 8304) after repair and 25% (n = 2553) after replacement; and 4% (n = 174) for isolated tricuspid repair and 24% (n = 1248) for isolated tricuspid replacement. Multivariable analysis showed baseline characteristics, endocarditis, concomitant operations, longer cardiopulmonary bypass time, tricuspid replacement, and lower hospital and surgeon tricuspid operative volumes were independently associated with greater risk for a PPM. After adjustment, tricuspid replacement had 3.2-times greater PPM risk compared with tricuspid repair.</div></div><div><h3>Conclusions</h3><div>Nationally, 15% of patients undergoing tricuspid operations required postoperative PPM implantation. PPM risk was increased with concomitant valve operations, tricuspid replacement, longer cardiopulmonary bypass time, and operations performed by less experienced surgeons and centers. Innovation is needed to decrease this significant morbidity.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 377-387"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480073","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":"Mechanisms of Repair Failure After Mitral Valve Repair Using Chordal Replacement","authors":"Miriam Lang MD ,&nbsp;Nina Feirer MD ,&nbsp;Bernhard Voss MD ,&nbsp;Arnar Geirsson MD ,&nbsp;Andrea Amabile MD ,&nbsp;Markus Krane MD ,&nbsp;Keti Vitanova MD","doi":"10.1016/j.athoracsur.2024.10.029","DOIUrl":"10.1016/j.athoracsur.2024.10.029","url":null,"abstract":"<div><h3>Background</h3><div>Mechanisms of repair failure after mitral valve repair (MVr) using chordal replacement and annuloplasty for degenerative mitral regurgitation were analyzed.</div></div><div><h3>Methods</h3><div>All mitral valve reoperations after isolated MVr using solely chordal replacement and annuloplasty for degenerative mitral regurgitation at the German Heart Center Munich (Munich, Germany) were reviewed. This retrospective observational study aimed to analyze mechanisms of repair failure leading to reoperations.</div></div><div><h3>Results</h3><div>Between 2003 and 2010, a total of 344 patients underwent MVr with chordal replacement and annuloplasty. During a mean follow-up of 9.7 years (range, 0-15.9 years), reoperation on the mitral valve was necessary in 38 (11.0%) cases. Reoperations were performed after a mean of 6.8 years (range, 0-14.1 years). The mechanisms of MVr failure were disease progression (39.5%), technical failure (36.8%), and endocarditis (18.4%). Re-repair was performed in 28.9% and was accomplished using redo annuloplasty (90.9%), chordal replacement (90.9%), resection techniques (27.3%), and leaflet patch reconstruction (9.1%). One patient (2.6%) underwent transcatheter edge-to-edge repair for reoperation. Mitral valve replacement (MVR) was necessary in 63.2%. Redo MVr was mainly performed in cases of technical failure, and MVR was more frequently performed in patients with mitral valve sclerosis. Repeat reoperation was necessary in 3 of 24 cases of MVR and in 2 of 11 cases of redo MVr after a median of 3.8 years (range, 0.01-10.04 years).</div></div><div><h3>Conclusions</h3><div>MVr using chordal replacement allows a variety of methods for re-repair, including transcatheter solutions. Redo MVr is more often feasible in cases of technical failure, whereas MVR for reoperation is more frequently necessary in patients with mitral valve sclerosis.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 362-369"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739587","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":"Society Board","authors":"","doi":"10.1016/S0003-4975(24)01049-X","DOIUrl":"10.1016/S0003-4975(24)01049-X","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Page A3"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143348592","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":"Longitudinal Follow-up of Medicare Patients After Esophageal Cancer Resection in the STS Database","authors":"Justin D. Blasberg MD MPH ,&nbsp;Elliot Servais MD ,&nbsp;Dylan Thibault MS ,&nbsp;Jeffrey P. Jacobs MD ,&nbsp;Benjamin Kozower MD ,&nbsp;Elizabeth David MD ,&nbsp;James Donahue MD ,&nbsp;Andrew Vekstein MD ,&nbsp;Lillian Kang MD ,&nbsp;Matthew Hartwig MD ,&nbsp;Leigh Ann Jones MS ,&nbsp;Andrzej Kosinski PhD ,&nbsp;Robert Habib MD ,&nbsp;Christopher Towe MD ,&nbsp;Christopher W. Seder MD","doi":"10.1016/j.athoracsur.2024.07.034","DOIUrl":"10.1016/j.athoracsur.2024.07.034","url":null,"abstract":"<div><h3>Background</h3><div>Understanding characteristics associated with survival after esophagectomy for cancer is critical to preoperative risk stratification. This study sought to define predictors for long-term survival after esophagectomy for cancer in Medicare patients.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons General Thoracic Surgery Database was queried for patients aged ≥65 years who underwent esophagectomy for cancer between 2012 and 2020 and linked to Centers for Medicare and Medicaid Services (CMS) data using a deterministic matching algorithm. Patient, hospital, and treatment variables were assessed using a multivariable Cox proportional hazards model to evaluate characteristics associated with long-term mortality and readmission. Kaplan-Meier and cumulative incidence curves were generated and differences evaluated using the log-rank test and Gray’s test, respectively.</div></div><div><h3>Results</h3><div>After CMS linkage, 4798 patients were included. Thirty-day and 90-day mortality in the study group was 3.84% and 7.45%, respectively. In the multivariable model, American Society of Anesthesiologists score &gt;3, body mass index &gt;35, and diabetes were associated with increased mortality &lt;90 days post-surgery, while pN/pT upstaging was associated with increased mortality &gt;90 days post-surgery. Patients upstaged to pN(+) had a 147% increased mortality risk (adjusted hazard ratio [aHR], 2.47; 95% CI, 2.02-3.02) and those that remained pN(+) a 75% increased mortality risk (aHR, 1.75; 95% CI, 1.57-1.95) compared with downstaged patients. Patients who were pT upstaged had a 109% (aHR, 2.09; 95% CI, 1.73-2.53) increased mortality risk compared with pT downstaged patients. Risk for readmission was independent of procedure type or approach and was higher in c stage ≥2, American Society of Anesthesiologists score ≥4, and pN+.</div></div><div><h3>Conclusions</h3><div>Medicare patients undergoing esophagectomy for cancer have identifiable patient-specific predictors for short-term mortality and tumor-specific predictors for long-term mortality and readmission. In the absence of pathologic T and N downstaging, risk for long-term mortality and readmission are increased.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 333-342"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989485","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 in Adult Congenital Heart Disease Patients With Down Syndrome Undergoing a Cardiac Surgical Procedure","authors":"Sarah W. Goldberg MD, MPH ,&nbsp;Chereen Chalak BSN, RN ,&nbsp;Brett R. Anderson MD, MBA ,&nbsp;Justin Elhoff MD, MSCR ,&nbsp;Stephanie Gaydos MD ,&nbsp;Adam M. Lubert MD ,&nbsp;Peter Sassalos MD ,&nbsp;Kimberlee Gauvreau ScD ,&nbsp;Michelle Gurvitz MD","doi":"10.1016/j.athoracsur.2024.09.037","DOIUrl":"10.1016/j.athoracsur.2024.09.037","url":null,"abstract":"<div><h3>Background</h3><div>As the life expectancy of patients with Down syndrome (DS) improves, the number of older patients with DS who require a cardiac surgical procedure for congenital heart disease will increase. Perioperative risk factors and outcomes in these patients are unknown.</div></div><div><h3>Methods</h3><div>In a multicenter retrospective study, teenaged and adult patients with DS who underwent a cardiac surgical procedure between 2008 and 2018 were matched by age and surgical procedure with patients who did not have DS. Demographic, medical, and surgical characteristics were compared. Outcome measures were length of stay (LOS), duration of mechanical ventilation, need for noninvasive positive pressure ventilation and reintubation, additional cardiac interventions, postoperative infections, and early postoperative mortality. Risk factors for extended hospital LOS (&gt;10 days) were explored using multivariable logistic regression.</div></div><div><h3>Results</h3><div>The study compared 121 patients with DS with 121 patients who did not have DS. Patients with DS had a longer median LOS (7 days vs 5 days; <em>P</em> &lt; .001), a longer duration of mechanical ventilation (12.5 hours vs 6.7 hours; <em>P</em> &lt; .001), greater need for noninvasive positive pressure ventilation or reintubation (26% vs 4%; <em>P</em> &lt; .001), and a higher likelihood of postoperative infections (10% vs 2%; <em>P</em> = .035). There was no early mortality. Preoperative risk factors for extended LOS for patients with DS included pulmonary medication use (odds ratio [OR], 4.0; <em>P</em> = .046), a history of immunodeficiency (OR, 10.4; <em>P</em> = .004), or moderate or greater tricuspid regurgitation (OR, 12.7; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Teenaged and adult patients with DS who underwent congenital a cardiac surgical procedure had a longer hospital LOS and more postoperative respiratory and infectious complications compared with patients who did not have DS, without increased mortality. A cardiac surgical procedure can be performed safely in older patients with DS. Management of pulmonary disease, immunodeficiency, and tricuspid regurgitation may mitigate risk.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 398-405"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480077","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":"Does Timing Matter? The Effect of Intensive Care Unit Arrival Timing on Elective Cardiac Surgery","authors":"Alex M. Wisniewski MD, MSc ,&nbsp;Sanjana Challa BS ,&nbsp;Raymond J. Strobel MD, MSc ,&nbsp;Anthony V. Norman MD, MSc ,&nbsp;Leora T. Yarboro MD ,&nbsp;Kenan Yount MD, MBA ,&nbsp;John Kern MD ,&nbsp;Michael Mazzeffi MD, MSc ,&nbsp;Nicholas R. Teman MD","doi":"10.1016/j.athoracsur.2024.08.004","DOIUrl":"10.1016/j.athoracsur.2024.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Due to staffing changes at scheduled intervals and decreases in essential staff in the evenings, late intensive care unit (ICU) arrivals may be at risk for suboptimal outcomes. Utilizing a regional collaborative, we sought to determine the effect of ICU arrival timing on outcomes in elective isolated coronary artery bypass.</div></div><div><h3>Methods</h3><div>Adults undergoing elective, isolated coronary artery bypass from 17 hospitals between 2013 and 2023 were identified. Patients with missing predicted risk of mortality or missing ICU arrival time were excluded. Late ICU arrival time was defined as between 6:00 <span>pm</span> and 6:00 <span>am</span>. Hierarchical logistic regression with appropriate predicted risk scores was utilized for outcome risk adjustment.</div></div><div><h3>Results</h3><div>We identified 11,638 patients, with 972 (8.4%) experiencing late ICU arrival. Late ICU arrival patients had higher predicted risk of morbidity or mortality (8.2%; [interquartile range {IQR}, 5.6%, 12.0%] vs 7.7% [IQR, 5.5%, 11.5%], <em>P</em> = .048) compared with early ICU arrival patients with longer median cardiopulmonary bypass times (96 minutes [IQR, 78, 119] vs 93 [IQR, 73, 116], <em>P</em> &lt; .001). Late ICU arrival patients experienced more unadjusted complications including prolonged ventilation (7.7% vs 4.2%, <em>P</em> &lt; .001) and operative mortality (2.0% vs 1.1%, <em>P</em> = .02), although no difference in failure-to-rescue (11.0% vs 10.4%, <em>P</em> = .84). Logistic regression with risk adjustment demonstrated late ICU arrival as a predictor of prolonged ventilation (odds ratio, 1.49 [95% CI, 1.12-1.99], <em>P</em> = .006).</div></div><div><h3>Conclusions</h3><div>After adjustment, late ICU arrivals experienced higher rates of prolonged ventilation, although this did not translate to failure-to-rescue.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 451-459"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057149","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":"Cardiac Surgical Bleeding, Transfusion, and Quality Metrics: Joint Consensus Statement by the Enhanced Recovery After Surgery Cardiac Society and Society for the Advancement of Patient Blood Management","authors":"Rawn Salenger MD ,&nbsp;Rakesh C. Arora MD, PhD ,&nbsp;Arthur Bracey MD ,&nbsp;Mario D’Oria MD ,&nbsp;Daniel T. Engelman MD ,&nbsp;Caroline Evans MD ,&nbsp;Michael C. Grant MD, MSE ,&nbsp;Serdar Gunaydin MD, PhD ,&nbsp;Vicki Morton DNP ,&nbsp;Sherri Ozawa MSN, RN ,&nbsp;Prakash A. Patel MD ,&nbsp;Jacob Raphael MD ,&nbsp;Todd K. Rosengart MD ,&nbsp;Linda Shore-Lesserson MD ,&nbsp;Pierre Tibi MD ,&nbsp;Aryeh Shander MD","doi":"10.1016/j.athoracsur.2024.06.039","DOIUrl":"10.1016/j.athoracsur.2024.06.039","url":null,"abstract":"<div><h3>Background</h3><div>Excessive perioperative bleeding is associated with major complications in cardiac surgery, resulting in increased morbidity, mortality, and cost.</div></div><div><h3>Methods</h3><div>An international expert panel was convened to develop consensus statements on the control of bleeding and management of transfusion and to suggest key quality metrics for cardiac surgical bleeding. The panel reviewed relevant literature from the previous 10 years and used a modified RAND Delphi methodology to achieve consensus.</div></div><div><h3>Results</h3><div>The panel developed 30 consensus statements in 8 categories, including prioritizing control of bleeding, prechest closure checklists, and the need for additional quality indicators beyond reexploration rate, such as time to reexploration. Consensus was also reached on the need for a universal definition of excessive bleeding, the use of antifibrinolytics, optimal cessation of antithrombotic agents, and preoperative risk scoring based on patient and procedural factors to identify those at greatest risk of excessive bleeding. Furthermore, an objective bleeding scale is needed based on the volume and rapidity of blood loss accompanied by viscoelastic management algorithms and standardized, patient-centered blood management strategies reflecting an interdisciplinary approach to quality improvement.</div></div><div><h3>Conclusions</h3><div>Prioritizing the timely control and management of bleeding is essential to improving patient outcomes in cardiac surgery. To this end, a cardiac surgical bleeding quality metric that is more comprehensive than reexploration rate alone is needed. Similarly, interdisciplinary quality initiatives that seek to implement enhanced quality indicators will likely lead to improved patient care and outcomes.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 280-295"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121106","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":"Gender Representation in Cardiothoracic Surgical Academia: A Call to Support Women Across the Globe","authors":"Cecilia Pompili MD, PhD ,&nbsp;Rita Costa MD ,&nbsp;Busra Cangut MD ,&nbsp;Isabelle Opitz MD ,&nbsp;Paula Ugalde Figueroa MD ,&nbsp;Daniela Molena MD ,&nbsp;Leah Backhus MD ,&nbsp;Shanda Blackmon MD ,&nbsp;Amy Fiedler MD ,&nbsp;Jolanda Kluin MD ,&nbsp;Julie Cleuziou MD ,&nbsp;Franca Melfi MD ,&nbsp;Stephanie Fuller MD ,&nbsp;Douglas E. Wood MD ,&nbsp;Mara B. Antonoff MD","doi":"10.1016/j.athoracsur.2024.10.012","DOIUrl":"10.1016/j.athoracsur.2024.10.012","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 274-279"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803272","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":"Impact of Hospital Transfers on Cardiac Surgery Outcomes: A Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis","authors":"Asvin M. Ganapathi MD ,&nbsp;Levi N. Bonnell PhD ,&nbsp;Michael E. Bowdish MD ,&nbsp;Jeffrey P. Jacobs MD ,&nbsp;Tsuyoshi Kaneko MD ,&nbsp;Bryan A. Whitson MD, PhD ,&nbsp;Robert H. Habib PhD","doi":"10.1016/j.athoracsur.2024.09.033","DOIUrl":"10.1016/j.athoracsur.2024.09.033","url":null,"abstract":"<div><h3>Background</h3><div>Transfers for cardiac surgery are not well studied. We sought to understand the risk profile of transferred patients and determine whether transfer rates vary by cardiac surgery and whether outcomes of transferred patients vary with type of referral hospital/surgery.</div></div><div><h3>Methods</h3><div>Patients undergoing cardiac surgery with operative risk models were identified from The Society of Thoracic Surgeons database between July 1, 2014, and December 31, 2022. Patients were stratified as no transfer, transferred from hospital with cardiac surgery, and transferred from hospital without cardiac surgery. Risk associated with transfer compared with no transfer was derived by using multivariable logistic regression for operative mortality and select perioperative outcomes.</div></div><div><h3>Results</h3><div>Included were 1,828,787 patients at 1145 hospitals, with 1,452,491 no-transfer patients (79.4%), 28,862 transfers (1.6%) from hospitals with cardiac surgery, and 347,434 transfers (19.0%) from hospitals without cardiac surgery. Most transferred patients underwent coronary artery bypass grafting (83.6%); however, transfers from hospitals with cardiac surgery were most common for mitral valve replacement (17.9%). Transferred patients had increased comorbid diseases and urgent/emergent procedures. In multivariable analysis, transfers from hospitals with/without cardiac surgery were not associated with differential risk of adverse outcomes by procedure type. Patients transferred from hospitals with cardiac surgery undergoing mitral and aortic valve replacement and coronary artery bypass grafting had significantly lower adjusted mortality risk compared with nontransferred patients, whereas composite morbidity/mortality was higher in mitral valve repair.</div></div><div><h3>Conclusions</h3><div>Patients transferred for cardiac surgery are generally higher risk; yet, outcomes at transfer to hospitals are as expected or better. However, further research is necessary to examine patients who are transferred but do not undergo surgery.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 442-450"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401884","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}