Annals of Thoracic Surgery最新文献

{"title":"Complex Bentall Operation: Clinical Pearls to Standardize the Procedure.","authors":"Suguru Ohira, Duke E Cameron, Steven L Lansman, David Spielvogel","doi":"10.1016/j.athoracsur.2024.09.013","DOIUrl":"10.1016/j.athoracsur.2024.09.013","url":null,"abstract":"<p><strong>Background: </strong>A straightforward Bentall operation can be performed safely with low mortality, but some challenging cases require a more complex operation. We discuss here the steps of the Bentall procedure.</p><p><strong>Methods: </strong>We reviewed specific scenarios, such as acute aortic dissection, native valve or prosthetic valve endocarditis, redo Bentall after aortic root replacement, calcified aortic root, and patients with prior coronary artery bypass grafting, mechanical aortic valve replacement, stentless aortic valve replacement, and prior extensive aortic arch repair with proximalization of neck vessels.</p><p><strong>Results: </strong>A variety of techniques were reported regarding reconstruction of aortic annulus (eg, Dacron [DuPont] graft is everted to create 5 to 6 crimps when sewing a bioprosthesis, and the height of the skirt can be adjusted depending on tissue defect) and reimplantation of coronary buttons. (Interposition of Dacron graft for coronary button reimplantation [original Cabrol technique], short interposition of Dacron graft is known as the Piehler technique, and technique in redo Bentall after prior aortic root replacement.) In patients with a history of coronary artery bypass grafting, direct reimplantation of a previous vein graft patch to the Dacron graft or interposition of a short Dacron graft were introduced. In addition, repair of coronary button in type A dissection or calcified aortic root were also described.</p><p><strong>Conclusions: </strong>Various techniques are available in modified Bentall operation. Surgeons should be familiar with the setup, anatomy of aortic root and surrounding structures, ways to treat tissue defect and prepare coronary buttons, and the various bailout procedures.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300209","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":"Commission on Cancer Standards for Lymph Node Sampling and Oncologic Outcomes After Lung Resection.","authors":"Benjamin J Resio, Kay See Tan, Matthew Skovgard, Joe Dycoco, Prasad S Adusumilli, Manjit S Bains, Matthew J Bott, Robert J Downey, Katherine D Gray, James Huang, Daniela Molena, Bernard J Park, Valerie W Rusch, Smita Sihag, Gaetano Rocco, David R Jones, James M Isbell","doi":"10.1016/j.athoracsur.2024.09.009","DOIUrl":"10.1016/j.athoracsur.2024.09.009","url":null,"abstract":"<p><strong>Background: </strong>The newest Commission on Cancer standards recommend sampling 3 mediastinal and 1 hilar lymph node stations, 3 (N2) 1 (N1), for lung cancer resections. However, the relationship between the Commission on Cancer standards and outcomes has not been thoroughly investigated.</p><p><strong>Methods: </strong>A prospective institutional database was queried for clinical stage I-III lung resections before the implementation of the new standards. The relationship between the 3 (N2) 1 (N1) standard (\"guideline concordant\") and outcomes (upstaging, complications, receipt of adjuvant therapy, locoregional/distant recurrence, and survival) was assessed with multivariable models and stratified by stage.</p><p><strong>Results: </strong>Of 9289 pulmonary resections, 3048 (33%) were guideline concordant and 6241 (67%) were not. Compared with nonconcordant, those that were guideline concordant had higher rates of nodal upstaging (21% vs 13%; odds ratio [OR], 1.32 [95% CI, 1.14-1.51]; P < .001) and in-hospital complications (34% vs 27%; OR, 1.17 [95% CI, 1.05-1.30]; P = .004) but similar adjuvant systemic therapy administration (19% vs 13%; OR, 1.09 [95% CI, 0.95-1.24]; P = .2; 98% chemotherapy). Locoregional and distant recurrences were not significantly improved with guideline concordance across clinical stage I, II, and III subsets. Overall survival was similar in clinical stages I and II, but improved survival was observed for guideline concordant clinical stage III patients (hazard ratio, 0.85 [95% CI, 0.74-0.97]; P = .02).</p><p><strong>Conclusions: </strong>Sampling 3 (N2) 1 (N1) was associated with increased upstaging and complications but not with decreased recurrence or mortality in clinical stage I or II patients. Survival was improved for concordant, clinical stage III patients. Further study is indicated to determine the ideal lymph node sampling strategy across heterogeneous lung cancer patients.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300167","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":"Long-Term Outcomes of Magnetic Sphincter Augmentation: A Comparative Study to Nissen Fundoplication","authors":"Kelly E. Daus MD ,&nbsp;Alexander S. Farivar MD ,&nbsp;Adam J. Bograd MD ,&nbsp;Peter T. White MD ,&nbsp;Ralph W. Aye MD ,&nbsp;Brian E. Louie MD","doi":"10.1016/j.athoracsur.2024.09.010","DOIUrl":"10.1016/j.athoracsur.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>Magnetic sphincter augmentation (MSA) demonstrates improvement in gastroesophageal reflux disease (GERD) across multiple short-term studies. Long-term, single-arm studies show durable outcomes, but there is limited comparative data to Nissen fundoplication (NF).</div></div><div><h3>Methods</h3><div>We performed a retrospective propensity-matched cohort study of patients with GERD undergoing MSA or NF between 2012 and 2018. Patients were matched on age, sex, body mass index, size of hiatal hernia, length of Barrett esophagus, and motility in a 1:1 fashion. A total of 523 patients (177 MSA, 346 NF) underwent surgery and after matching 177 MSA and 177 NF cases were analyzed.</div></div><div><h3>Results</h3><div>At 1 year, GERD quality of life scores improved (22 to 5 MSA vs 24 to 5 NF, <em>P</em> = .593). Proton pump inhibitor use was 14% vs 5% (<em>P</em> = .010). pH testing demonstrated improved DeMeester scores (42 to 21 vs 46 to 7, <em>P</em> &lt; .001). At 5 years, GERD quality of life scores were stable (5 to 5 vs 5 to 4, <em>P</em> = .208). Proton pump inhibitor use was 31% vs 26% (<em>P</em> = .474). The incidence of endoscopic dilation was similar between MSA and NF (7% vs 10%, <em>P</em> = .347). Reoperation rates were higher for MSA (10% vs 4%, <em>P</em> = .022) and recurrent hiatal hernias were found in 18% vs 7% (<em>P</em> = .007). Compared to NF, MSA undergoing complete dissection showed no difference in dilation (5% MSA vs 7% NF, <em>P</em> = .527), reoperation (8% MSA vs 6% NF, <em>P</em> = .684) or hernia recurrence (10% MSA vs 6% NF, <em>P</em> = .432).</div></div><div><h3>Conclusions</h3><div>MSA achieves similar improvements in quality of life and freedom from medical therapy compared to NF, especially with complete hiatal repair.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"118 6","pages":"Pages 1207-1214"},"PeriodicalIF":3.6,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300213","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":"Ten-Year Survivals of Right Thoracic vs Left Thoracic Approach for Esophageal Cancer.","authors":"Bin Li, Zezhou Wang, Yihua Sun, Hong Hu, Yawei Zhang, Jiaqing Xiang, Haiquan Chen","doi":"10.1016/j.athoracsur.2024.09.006","DOIUrl":"10.1016/j.athoracsur.2024.09.006","url":null,"abstract":"<p><strong>Background: </strong>Esophagectomy can be performed using various surgical techniques. The aim of this study was to understand the impact of surgery on long-term survival for esophageal cancer.</p><p><strong>Methods: </strong>Between May 2010 and July 2012, 300 patients with esophageal cancer were randomly assigned to undergo esophagectomy with either a left or right thoracic approach. Disease-free survival (DFS) and overall survival (OS) were compared based on the per-protocol principle among 286 patients with esophageal squamous cell carcinoma determined by postoperative pathologic results (146 in the right and 140 in the left thoracic arms).</p><p><strong>Results: </strong>The median DFS was 92 months in the right thoracic arm and 41 months in the left thoracic arm (hazard ratio, 0.73; 95% CI, 0.54-0.99; P = .045), with a cumulative 10-year DFS of 47.6% and 37.5%, respectively. The median OS was 136 months in the right thoracic arm and 99 months in the left thoracic arm (hazard ratio, 0.75; 95% CI, 0.54-1.04; P = .081), with cumulative 10-year OS of 52.4% and 43.7%, respectively. DFS and OS were comparable between the 2 arms for patients without lymph node metastasis. Conversely, for patients with lymph node metastasis, 10-year DFS was 32.7% and 21.4%, respectively (P = .018), and 10-year OS of the right and left thoracic arms was 37.9% and 25.9%, respectively (P = .012).</p><p><strong>Conclusions: </strong>Compared with the left thoracic approach, patients who underwent esophagectomy through the right thoracic approach had better 10-year survival rates, and the survival benefit was significant for those with lymph node metastasis.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300233","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":"Fate of Abstracts Presented at Annual Meetings of The Society of Thoracic Surgeons from 2015 to 2019.","authors":"Carlos A Valdes, Ahmet Bilgili, Griffin Stinson, Ramy M Sharaf, Omar M Sharaf, Zachary Brennan, Fabian Jimenez-Contreras, Giles J Peek, Mark S Bleiweis, Thomas M Beaver, Jeffrey Phillip Jacobs","doi":"10.1016/j.athoracsur.2024.09.005","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.005","url":null,"abstract":"<p><strong>Background: </strong>Society of Thoracic Surgeons (STS) annual meetings provide opportunities to disseminate cardiothoracic research. We assessed rates of publication of STS abstracts as manuscripts in peer-reviewed journals over five years and determined factors associated with successful publication.</p><p><strong>Methods: </strong>The STS \"Annual Meeting Archive\" was searched online for abstract books from STS annual meetings from 2015-2019. Abstract books were reviewed for information about presented abstracts. A PubMed and Google search was then performed to identify corresponding peer-reviewed journal publications.</p><p><strong>Results: </strong>A total of 1451 abstracts were presented at STS annual meetings from 2015-2019. Overall publication rate of accepted abstracts as manuscripts in peer-reviewed journals was 1097/1451=75.60%. Most published manuscripts were published in The Annals of Thoracic Surgery (750/1097=68.37%). Median duration between abstract presentation and peer-reviewed journal publication was 313[IQR=212.5-458] days. Only 29/1451=2.00% of abstracts won an award, and all 29 of these award-winning abstracts were published as a manuscript. Oral presentation was associated with increased odds of publication compared to poster presentation (OR=1.28[95% CI=1.04-1.71], p=0.021). Median 5-year impact factor of peer-reviewed journals containing these manuscripts was 5.04[IQR=5.04-5.04], and corresponding manuscripts were cited a median of 4[IQR=1-9] times. Overall, 836/1097=76.20% of manuscripts published in peer-reviewed scientific journals had a corresponding North American author.</p><p><strong>Conclusions: </strong>Annual STS meetings are a forum for the presentation of high-quality research. The rate of publication of accepted STS abstracts as manuscripts in peer-reviewed journals is >75%, comparing favorably with national meetings of other surgical societies, and >2/3 of published manuscripts are published in STS's official journal.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300211","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":"Long-term Results of Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection.","authors":"Bradley G Leshnower, Woodrow J Farrington, Lauren V Huckaby, William B Keeling, Alysa B Zellner, Edward P Chen","doi":"10.1016/j.athoracsur.2024.09.007","DOIUrl":"10.1016/j.athoracsur.2024.09.007","url":null,"abstract":"<p><strong>Background: </strong>Valve preservation in acute type A aortic dissection (ATAAD) can be accomplished with root repair or replacement. Long-term valve durability with root repair has been established, but limited data exist regarding long-term durability of valve-sparing root replacement (VSRR). In this study, long-term results of VSRR were compared with root repair in ATAAD.</p><p><strong>Methods: </strong>From 2005 to 2023, 866 patients underwent ATAAD repair, of which 675 underwent root repair and 191 underwent root replacement (VSRR, n = 65; Bentall, n =126). VSRR patients were compared with 123 patients who underwent valve resuspension and root repair with postoperative echocardiograms ≥1 year.</p><p><strong>Results: </strong>VSRR patients were younger (VSRR, 44 ± 11 years vs root repair, 55 ± 13 years; P < .001). Preoperatively, 57% of VSRR and 35% of root repair patients had moderate or more aortic insufficiency. Cardiopulmonary bypass and myocardial ischemia times were significantly longer in VSRR (P < .001). Postoperative echocardiograms with ≥1 year follow-up were analyzed in 58 VSRR patients with median follow-up of 4.8 years (interquartile range, 3-12 years) and in 123 root repair patients with median follow-up of 3.6 years (interquartile range, 3-8 years). At 10 years, VSRR patients had superior freedom from more than mild aortic insufficiency (VSRR, 91% vs root repair, 49%; P < .001). At 10 years, freedom from aortic valve replacement was equivalent (VSRR, 98% vs root repair, 92%; P = .269).</p><p><strong>Conclusions: </strong>VSRR provides equivalent long-term valve durability as root repair in ATAAD, even in patients with moderate or severe aortic insufficiency. In select young patients who require root replacement during ATAAD repair, VSRR represents an ideal therapy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300215","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":"Incidence and Outcomes of Iatrogenic Complete Atrioventricular Block After Congenital Heart Surgery.","authors":"Mario O'Connor, Andrew Well, Arnold Fenrich, Neil M Venardos, Daniel Shmorhun, Carlos M Mery, Charles D Fraser","doi":"10.1016/j.athoracsur.2024.09.002","DOIUrl":"10.1016/j.athoracsur.2024.09.002","url":null,"abstract":"<p><strong>Background: </strong>Iatrogenic complete atrioventricular block (ICAVB) has long been noted as a major complication after congenital heart surgery (CHS), and it contributes to complex postoperative care and potentially affects patients' outcomes.</p><p><strong>Methods: </strong>This study is a retrospective review of the Pediatric Health Information System database from January 1, 2004 to September 30, 2023. All patients who underwent The Society of Thoracic Surgeons benchmark procedures were included. International Classification of Diseases (ICD) 9th and 10th editions were used to identify diagnoses and procedures. All patients with a diagnosis of complete atrioventricular block and placement of a permanent pacemaker after CHS but in the same hospitalization were identified as having ICAVB.</p><p><strong>Results: </strong>A total of 42,332 patients were identified, with 17,106 (41%) female and 23,042 (55%) non-Hispanic White and with a median age of 5.4 months [interquartile range, 0.4-25.8 months]. Of those patients, 246 (0.6%) had ICAVB. The procedure with the highest incidence of ICAVB was the arterial switch operation with ventricular septal defect (VSD) repair (74 of 1552; 4.5%). On multivariable analysis, the arterial switch operation with VSD repair had the highest adjusted odds of ICAVB (odds ratio, 5.41; 95% CI, 3.57-8.19; P < .001) when compared with isolated VSD repair. A diagnosis of endocarditis was significantly associated with ICAVB. Center volume was not associated with ICAVB. ICAVB was associated with a 121% (95% CI, 98.5%-146.8%) increase in length of stay (P < .001) and increased in-hospital mortality (odds ratio, 2.26; 95% CI, 1.34-3.82; P < .001).</p><p><strong>Conclusions: </strong>The overall incidence of ICAVB after CHS is low. However, certain procedures have incidences as high as 4.5%. ICAVB is associated with increased postoperative mortality and length of stay. Further work is needed to identify drivers of variation among centers to improve overall outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300212","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":"Long-term Outcomes of Mitral Valve Repair for Atrial Functional Mitral Regurgitation.","authors":"Jung-Hoon Shin, Seung-Hyun Lee, Hyun-Chul Joo, Young-Nam Youn, Jung-Hwan Kim, Sak Lee","doi":"10.1016/j.athoracsur.2024.09.001","DOIUrl":"10.1016/j.athoracsur.2024.09.001","url":null,"abstract":"<p><strong>Background: </strong>Atrial functional mitral regurgitation (AFMR), defined by normal left ventricular function, enlarged left atrium, and a dilated mitral valve annulus, has been a concept discussed for >10 years. However, there are still no established guidelines for its treatment in the American College of Cardiology/American Heart Association recommendations. This study aimed to determine the long-term outcomes of mitral annuloplasty as a treatment for AFMR.</p><p><strong>Methods: </strong>We analyzed 1435 patients who underwent mitral valve repair at our institution between 2005 and 2020, with 162 classified as having AFMR. Exclusion criteria for AFMR were established based on preoperative echocardiography and operative notes. The primary outcome was overall mortality, and the secondary outcome was MR recurrence, which was defined as moderate or greater mitral regurgitation observed on echocardiography during the follow-up period, analyzed using our hospital's medical records and data from the National Statistical Office.</p><p><strong>Results: </strong>The median follow-up duration for the entire patient cohort was 6.1 years (interquartile range, 3.2-11.2 years). Patients had a 5-year survival rate of 86% and a 10-year survival rate of 73%, with freedom from MR recurrence rates of 89% and 80% at 5 and 10 years, respectively. Although all 162 patients had moderate or greater MR before surgery, most experienced trivial or mild MR after mitral valve repair throughout the follow-up period.</p><p><strong>Conclusions: </strong>In summary, mitral valve repair effectively treats patients with AFMR, addressing survival and mitigating MR recurrence.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300214","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 a Novel Single Branched Aortic Stent Graft for Treatment of Type B Aortic Dissection.","authors":"Nimesh D Desai, Grace J Wang, William Brinkman, Joseph Coselli, Bradley Taylor, Himanshu Patel, Michael Dake, Fernando Fleischman, Jean Panneton, Jon Matsumura, Matthew Sweet, Randall DeMartino, Bradley Leshnower, Luis Sanchez, Joseph E Bavaria","doi":"10.1016/j.athoracsur.2024.07.053","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.07.053","url":null,"abstract":"<p><strong>Background: </strong>Intervention on Type B dissection frequently requires landing the proximal edge of the stent graft between the left common carotid artery and left subclavian artery (LSA). The Gore® TAG® Thoracic Branch Endoprosthesis (TBE) is a technology which allows LSA preservation with a single internal branch.</p><p><strong>Methods: </strong>This study was a prospective non-randomized single-arm clinical trial of patients with type B aortic dissection that were treated with the single branched device. Patients with operative indications for acute, chronic or residual Type B dissections that originated distal to the origin of a left subclavian artery suitable for branch graft placement were eligible for the study. Native aortic and surgical graft proximal landing zones were eligible.</p><p><strong>Results: </strong>Among the 132 patients, there were 25 (18.9%) acute type B dissections, 79 (59.8%) of chronic type B dissections and 28 (21.1%) of residual dissections after previous open Type A repair. Percutaneous access was used in 105 (79.5%) patients. Overall, 30-day mortality occurred in 6 patients (4.5%). The overall 30 day stroke rate was 2/132(1.5%) and the one-year freedom from stroke was 96.8%. Device Technical Success and Procedural Success was achieved in 129/132(97.7%) and 110/132(83.3%) of subjects, respectively and there was one instance of loss of side branch patency. There was no persistent antegrade false lumen flow observed.</p><p><strong>Conclusions: </strong>In this study of a novel branched endograft device to preserve the LSA in patients with type B dissection undergoing TEVAR, we demonstrate acceptable safety and efficacy outcomes at one year.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300230","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":"Thromboelastography-guided Intraoperative Platelet Transfusion in Pediatric Heart Surgery","authors":"Sirisha Emani PhD ,&nbsp;Reece Donahue BS ,&nbsp;Aminah Callender BS ,&nbsp;Merhawi Ghebremichael BS ,&nbsp;Meena Nathan MD, MPH ,&nbsp;Juan C. Ibla MD, MS ,&nbsp;Sitaram Emani MD","doi":"10.1016/j.athoracsur.2024.09.003","DOIUrl":"10.1016/j.athoracsur.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative bleeding is associated with significant resource use and is an important contributor to other major adverse events in pediatric patients undergoing complex cardiac surgical procedures. Thromboelastography (TEG; TEG 6S, Haemonetics) can guide perioperative blood product transfusions to reduce the risk of postoperative bleeding. This study validated the use of a previously developed TEG 6S maximum amplitude (TEG-MA)–based platelet transfusion calculator used during cardiac surgical procedures to minimize the risk of postoperative bleeding.</div></div><div><h3>Methods</h3><div>In this single-center retrospective study of pediatric patients (aged ≤18 years) who underwent cardiac surgical procedures requiring cardiopulmonary bypass at Boston Children’s Hospital (Boston, MA) (N = 1000), the volume of platelet transfusion administered at surgical team discretion was compared with the platelet calculator–recommended platelet transfusion volume by using linear regression analysis. Associations between the adequacy of perioperative platelet transfusion and postoperative bleeding or thrombotic complications within the first 24 hours postoperatively (bleeding) and until hospital discharge (thrombosis) were evaluated by logistic regression analysis.</div></div><div><h3>Results</h3><div>Lower TEG-MA (≤45 mm) measurements after transfusion were associated with a higher risk for postoperative bleeding (odds ratio, 4.4; 95% CI, 2.6-7.4; <em>P</em> &lt; .01 [significant <em>P</em> value &lt;.05]). The platelet transfusion calculator–recommended platelet transfusion volume (on the basis of TEG-MA measured at the time of rewarming) demonstrated moderate correlation with the measured TEG-MA value after platelet transfusion (Pearson <em>r</em> = 0.7). Intraoperative volumes of platelet transfusion that failed to increase a postoperative TEG-MA of at least 45 mm significantly increased the risk for postoperative bleeding in the first 24 hours after surgical procedures (odds ratio, 3.2; 95% CI, 1.9-5.4; <em>P</em> &lt; .01 [significant <em>P</em> value &lt;.05]). The posttransfusion TEG-MA was not independently associated with thrombosis.</div></div><div><h3>Conclusions</h3><div>Customizing perioperative platelet transfusion therapy by using quantitative diagnostic tests can help reduce postoperative bleeding complications.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"118 6","pages":"Pages 1271-1278"},"PeriodicalIF":3.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300234","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}