{"title":"Carinal resections-Not for the faint of heart.","authors":"Cameron D Wright","doi":"10.1016/j.athoracsur.2024.11.006","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.11.006","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631899","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 Next Steps.","authors":"Anthony Estrera","doi":"10.1016/j.athoracsur.2024.11.003","DOIUrl":"10.1016/j.athoracsur.2024.11.003","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631993","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}
Anastasiia K Tompkins, David T Cooke, Leah Backhus, J Michael DiMaio, Sara J Pereira, Mara Antonoff, Walter Merrill, Cherie P Erkmen, Sara Pereira, Cherie P Erkmen, Leah M Backhus, Ian C Bostock Rosenzweig, Donnell Bowen, David Tom Cooke, Loretta Erhunmwunsee, Kirsten A Freeman, Luis Godoy, Deborah Kozik, Jacques Kpodonu, Kiran H Lagisetty, Glenn J Pelletier, Smita Sihag, Africa F Wallace, Fatima Wilder, Douglas E Wood
{"title":"Intersection of Race and Gender in the Cardiothoracic Workforce: Study of Representation and Salary.","authors":"Anastasiia K Tompkins, David T Cooke, Leah Backhus, J Michael DiMaio, Sara J Pereira, Mara Antonoff, Walter Merrill, Cherie P Erkmen, Sara Pereira, Cherie P Erkmen, Leah M Backhus, Ian C Bostock Rosenzweig, Donnell Bowen, David Tom Cooke, Loretta Erhunmwunsee, Kirsten A Freeman, Luis Godoy, Deborah Kozik, Jacques Kpodonu, Kiran H Lagisetty, Glenn J Pelletier, Smita Sihag, Africa F Wallace, Fatima Wilder, Douglas E Wood","doi":"10.1016/j.athoracsur.2024.09.053","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.053","url":null,"abstract":"<p><strong>Background: </strong>Cardiothoracic surgery lacks gender and racial/ethnic diversity. Recent studies highlighted disparities based on gender and race/ethnicity among academic cardiothoracic surgeons. The impact of the intersection of these factors on representation and salary is unknown.</p><p><strong>Methods: </strong>A cross-sectional analysis of Accreditation Council for Graduate Medical Education and Association of American Medical Colleges data was performed on the number of trainees and clinical faculty stratified by race/ethnicity and gender using Chi-square testing.</p><p><strong>Results: </strong>The number of women and underrepresented minorities was low in cardiothoracic surgery compared to other specialties, with lowest representation at the intersection of race/ethnicity and gender. Among trainees, 8% were Asian, 2% were Black/African American , and 1.5% were Hispanic/Latina women. Among cardiothoracic faculty, 3.4% were Asian, 0.8% were Black/African American, and 0.4% were Hispanic/Latina women. Women in academic medicine, surgery and cardiothoracic surgery earned 80-87% the salary of men of equal academic rank. White assistant professors earned more than their colleagues (all clinical faculty, surgeons and cardiothoracic surgeons), this difference was further compounded by gender.</p><p><strong>Conclusions: </strong>Salary disparities exist among cardiothoracic surgeons at the intersection of gender and race/ethnicity. Women experience salary disparity across all academic ranks and specialties. When considering the intersection of gender and race/ethnicity, gender is the predominant factor driving salary inequity.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631979","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":"Harvey W. Bender Jr: Son of Texas, Gifted Surgeon, Inspiring Teacher, STSA and ACS President.","authors":"Walter H Merrill, Richard L Prager","doi":"10.1016/j.athoracsur.2024.09.049","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.049","url":null,"abstract":"<p><p>Harvey W. Bender Jr spent his early years in Humble, Texas. After attending Baylor University College of Medicine, he trained in surgery at the Johns Hopkins Hospital. In 1971 he was recruited to Vanderbilt University to reinvigorate the residency training program and significantly expand the clinical services. He became Chair of the Residency Review Committee for Thoracic Surgery and of the American Board of Thoracic Surgery. He was also Chair of the Board of Regents, President of the American College of Surgeons, and President of the Southern Thoracic Surgical Association. He was a unique person whose influence will last for generations.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631969","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":"Neurocognitive Dysfunction After Short-Duration (<20 Minutes) Hypothermic Circulatory Arrest: Evidence from the GOT ICE Study.","authors":"Eilon Ram, Leonard N Girardi","doi":"10.1016/j.athoracsur.2024.10.025","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.10.025","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631987","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}
Brett F Curran, Hartzell V Schaff, Heidi M Connolly, Joseph M Dearani, William R Miranda, David S Majdalany, Malakh L Shrestha
{"title":"Late Outcomes of Ascending-to-Descending Bypass for Aortic Coarctation.","authors":"Brett F Curran, Hartzell V Schaff, Heidi M Connolly, Joseph M Dearani, William R Miranda, David S Majdalany, Malakh L Shrestha","doi":"10.1016/j.athoracsur.2024.10.026","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.10.026","url":null,"abstract":"<p><strong>Background: </strong>Ascending-to-descending aortic bypass is a repair option for patients with complex aortic coarctation. This technique is reported to have minimal early morbidity and mortality, however, the long-term results of the procedure are unknown.</p><p><strong>Methods: </strong>We analyzed the late outcomes of 81 consecutive patients with aortic coarctation who underwent ascending-to-descending aortic bypass through a median sternotomy from January 1985 to December 2012. The study was limited to this interval to allow for a minimum of 10-year follow-up. Fifty-two patients had recurrent coarctation after previous repair, and 44 patients had concomitant cardiac procedures at the time of ascending-to-descending bypass.</p><p><strong>Results: </strong>There was no perioperative mortality, and overall survival at 5, 10, and 20 years was 94%, 90%, and 85%, similar to an age and sex-matched population. There were no interventions for the ascending-to-descending bypass during follow-up, and no deaths were known to be related to the bypass graft. Subsequent cardiac operations were performed through a median sternotomy in 7 patients (9%), and late imaging in 48 patients (59%) demonstrated no hemodynamically significant stenoses or pseudoaneurysms. At late follow-up, median systolic blood pressure was 124 mmHg, and half of the patients were on no or only one antihypertensive.</p><p><strong>Conclusions: </strong>Ascending-to-descending aortic bypass is a safe operation with excellent long-term outcomes for adult patients with complex aortic coarctation. The procedure is durable and appears to improve systemic hypertension. Importantly, ascending-to-descending bypass does not hinder the safe performance of subsequent operations performed through a median sternotomy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631983","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}
Margaret E Yang, Alexandra Potter, Deepti Srinivasan, Arian Mansur, Larisa Shagabayeva, Danny Wang, Chi-Fu Jeffrey Yang
{"title":"Optimal Treatment Strategies for Early-Stage Primary Mediastinal Germ Cell Tumors.","authors":"Margaret E Yang, Alexandra Potter, Deepti Srinivasan, Arian Mansur, Larisa Shagabayeva, Danny Wang, Chi-Fu Jeffrey Yang","doi":"10.1016/j.athoracsur.2024.10.021","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.10.021","url":null,"abstract":"<p><strong>Background: </strong>Data on optimal therapy for patients with primary mediastinal germ cell tumors consist overwhelmingly of single-institution studies with small sample sizes. The objective of this study is to assess the association of survival outcomes with surgery vs non-operative management for patients with early-stage primary mediastinal germ cell tumors.</p><p><strong>Methods: </strong>Overall survival of all patients with seminomas and non-seminomatous primary germ cell tumors in the mediastinum who received 1) chemotherapy, or 2) surgery with or without chemotherapy (referred to as 'surgery' for simplicity) for early-stage disease from 2004-2015 in the National Cancer Database was assessed using Kaplan-Meier analysis, propensity score-matched analysis, and multivariable Cox proportional hazards analysis.</p><p><strong>Results: </strong>Among patients with seminomas, chemotherapy alone was used in 120 (80.5%) patients and surgery was used in 29 (19.5%) patients. There was no significant difference in 5-year survival between surgery and chemotherapy in unadjusted and propensity score-matched analysis. Among patients with non-seminomatous tumors, chemotherapy alone was used in 91 (46.7%) patients and surgery was used in 104 (53.3%) patients. Surgery was associated with improved 5-year survival when compared to chemotherapy in unadjusted, and multivariable-adjusted, and propensity score-matched analysis.</p><p><strong>Conclusions: </strong>In this national analysis, multimodality treatment involving surgery was associated with improved survival when compared to chemotherapy alone for early-stage primary mediastinal non-seminomatous germ cell tumors. For seminomas of the mediastinum, chemotherapy was associated with similar long-term outcomes when compared to multimodality treatment involving surgery.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632008","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}
Ayesha P Ng, Yas Sanaiha, Joseph E Hadaya, Arjun Verma, Jane Yanagawa, Peyman Benharash
{"title":"Risk of Financial Toxicity Among Adults Undergoing Lung and Esophageal Resections for Cancer.","authors":"Ayesha P Ng, Yas Sanaiha, Joseph E Hadaya, Arjun Verma, Jane Yanagawa, Peyman Benharash","doi":"10.1016/j.athoracsur.2024.10.023","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.10.023","url":null,"abstract":"<p><strong>Background: </strong>Although financial toxicity, defined as the harmful financial burden experienced by patients undergoing cancer treatment, has been of growing interest, data in thoracic oncology are lacking. We aimed to examine the risk of financial toxicity among patients undergoing surgical resection of thoracic malignancies.</p><p><strong>Methods: </strong>Adults undergoing lobectomy, pneumonectomy, or esophagectomy for cancer were identified in the 2012-2021 National Inpatient Sample (NIS). Risk of financial toxicity was defined as health expenditure (total hospitalization costs for the uninsured and maximum out-of-pocket costs for the insured) exceeding 40% of post-subsistence income. Multivariable logistic regressions were used to identify factors associated with financial toxicity risk.</p><p><strong>Results: </strong>Of 384,340 patients, 69.5% had government-funded insurance, 27.2% private insurance, and 1.0% were uninsured. Compared to those with insurance, uninsured patients were more commonly Black and Hispanic and less commonly electively admitted. Mortality, complications, LOS, and costs were comparable regardless of insurance status. Approximately 68.9% of uninsured and 17.3% of insured patients were at risk of financial toxicity, and incidence of financial toxicity remained stable over time. After risk adjustment, complications were associated with over 2-fold increased risk of financial toxicity among uninsured (AOR 2.21, 95% CI 1.38-3.55). Among the insured, Black, Hispanic, and publicly insured patients demonstrated greater risk of financial toxicity, while minimally invasive operations and metropolitan hospitals exhibited lower risk of financial toxicity.</p><p><strong>Conclusions: </strong>Concordant with prior work examining financial toxicity in abdominal oncologic surgery, thoracic surgery demonstrates a comparable burden of financial toxicity. Referral policies and care subsidization may be considered in patients undergoing thoracic malignancy resections at risk for financial toxicity.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632010","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":"Genomic Alterations of Early-Onset Lung Adenocarcinoma: A Step in the Right Direction.","authors":"Whitney S Brandt","doi":"10.1016/j.athoracsur.2024.10.022","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.10.022","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631935","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":"Blurring of the Lines for Better Outcomes.","authors":"Russell Seth Martins, Faiz Y Bhora","doi":"10.1016/j.athoracsur.2024.10.018","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.10.018","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631897","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}