Annals of Thoracic Surgery最新文献

{"title":"Does Timing Matter? The Effect of Intensive Care Unit Arrival Timing on Elective Cardiac Surgery.","authors":"Alex M Wisniewski, Sanjana Challa, Raymond J Strobel, Anthony V Norman, Leora T Yarboro, Kenan Yount, John Kern, Michael Mazzeffi, Nicholas R Teman","doi":"10.1016/j.athoracsur.2024.08.004","DOIUrl":"10.1016/j.athoracsur.2024.08.004","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 pm and 6:00 am. Hierarchical logistic regression with appropriate predicted risk scores was utilized for outcome risk adjustment.</p><p><strong>Results: </strong>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%], P = .048) compared with early ICU arrival patients with longer median cardiopulmonary bypass times (96 minutes [IQR, 78, 119] vs 93 [IQR, 73, 116], P < .001). Late ICU arrival patients experienced more unadjusted complications including prolonged ventilation (7.7% vs 4.2%, P < .001) and operative mortality (2.0% vs 1.1%, P = .02), although no difference in failure-to-rescue (11.0% vs 10.4%, P = .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], P = .006).</p><p><strong>Conclusions: </strong>After adjustment, late ICU arrivals experienced higher rates of prolonged ventilation, although this did not translate to failure-to-rescue.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"451-459"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741921/pdf/","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":"OA","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, Chereen Chalak, Brett R Anderson, Justin Elhoff, Stephanie Gaydos, Adam M Lubert, Peter Sassalos, Kimberlee Gauvreau, Michelle Gurvitz","doi":"10.1016/j.athoracsur.2024.09.037","DOIUrl":"10.1016/j.athoracsur.2024.09.037","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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 (>10 days) were explored using multivariable logistic regression.</p><p><strong>Results: </strong>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; P < .001), a longer duration of mechanical ventilation (12.5 hours vs 6.7 hours; P < .001), greater need for noninvasive positive pressure ventilation or reintubation (26% vs 4%; P < .001), and a higher likelihood of postoperative infections (10% vs 2%; P = .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; P = .046), a history of immunodeficiency (OR, 10.4; P = .004), or moderate or greater tricuspid regurgitation (OR, 12.7; P < .001).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"398-405"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11741920/pdf/","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":"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, Rita Costa, Busra Cangut, Isabelle Opitz, Paula Ugalde Figueroa, Daniela Molena, Leah Backhus, Shanda Blackmon, Amy Fiedler, Jolanda Kluin, Julie Cleuziou, Franca Melfi, Stephanie Fuller, Douglas E Wood, Mara B Antonoff","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":" ","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":"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, Rakesh C Arora, Arthur Bracey, Mario D'Oria, Daniel T Engelman, Caroline Evans, Michael C Grant, Serdar Gunaydin, Vicki Morton, Sherri Ozawa, Prakash A Patel, Jacob Raphael, Todd K Rosengart, Linda Shore-Lesserson, Pierre Tibi, Aryeh Shander","doi":"10.1016/j.athoracsur.2024.06.039","DOIUrl":"10.1016/j.athoracsur.2024.06.039","url":null,"abstract":"<p><strong>Background: </strong>Excessive perioperative bleeding is associated with major complications in cardiac surgery, resulting in increased morbidity, mortality, and cost.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","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":"","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, Levi N Bonnell, Michael E Bowdish, Jeffrey P Jacobs, Tsuyoshi Kaneko, Bryan A Whitson, Robert H Habib","doi":"10.1016/j.athoracsur.2024.09.033","DOIUrl":"10.1016/j.athoracsur.2024.09.033","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","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}

{"title":"Avoiding a Permanent Pacemaker With Tricuspid Valve Surgery.","authors":"J Hunter Mehaffey, Vinay Badhwar","doi":"10.1016/j.athoracsur.2024.10.006","DOIUrl":"10.1016/j.athoracsur.2024.10.006","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"387-388"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512380","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 Society of Thoracic Surgeons Preoperative Beta Blocker Working Group Interim Report.","authors":"David M Shahian, Gaetano Paone, Robert H Habib, Carole Krohn, Bruce A Bollen, Jeffrey P Jacobs, Michael E Bowdish, Miklos D Kertai","doi":"10.1016/j.athoracsur.2024.06.038","DOIUrl":"10.1016/j.athoracsur.2024.06.038","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) occurs commonly after cardiac surgery and is associated with multiple adverse outcomes. Older randomized trials suggested that perioperative β- blockade reduced postoperative AF, and The Society of Thoracic Surgeons (STS) coronary artery bypass grafting (CABG) composite measure includes β-blocker administration preoperatively within 24 hours of surgery and at discharge. However, some more recent studies suggest preoperative β-blockade has limited value and question its continuation as an STS quality measure.</p><p><strong>Methods: </strong>In 2022, an STS Preoperative Beta Blocker Working Group was formed with representatives from the STS and the Society of Cardiovascular Anesthesiologists. Published randomized trials, observational studies, societal guidelines, and the current state of available data from the STS Adult Cardiac Surgery Database (ACSD) were reviewed.</p><p><strong>Results: </strong>Review of existing studies reveals substantial heterogeneity or insufficient detail regarding specific β-blockers used, timing of initiation, management of patients on chronic β-blockade, and whether other proarrhythmic or antiarrhythmic drugs were used concurrently. Further, β-blocker data currently collected in the STS ACSD lack sufficient granularity.</p><p><strong>Conclusions: </strong>Because a new randomized trial seems unlikely, the Working Group believes that more granular data on real-world practice would facilitate assessment of the value of preoperative β-blockade in the current era, development of best practice recommendations, and evaluation of their continued appropriateness as an STS quality metric. STS ACSD participants have been invited to participate in a voluntary survey whose additional data, when linked to STS ACSD records, will better delineate contemporary β-blocker practice and outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"476-484"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005783","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":"Do Not Go Gentle Into the Night: Nighttime Intensivist Coverage and Failure to Rescue.","authors":"Travis J Miles, Kyle W Blackburn, Subhasis Chatterjee","doi":"10.1016/j.athoracsur.2024.11.016","DOIUrl":"10.1016/j.athoracsur.2024.11.016","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"440-441"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774618","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 Survival Benefit of Surgical Atrial Fibrillation Ablation in Mitral Surgery.","authors":"Irbaz Hameed, Alexander Iribarne","doi":"10.1016/j.athoracsur.2024.08.012","DOIUrl":"10.1016/j.athoracsur.2024.08.012","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"263-264"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114522","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":"Clinical and Angiographic Outcomes of Bilateral Internal Thoracic Artery Revascularization: In Situ vs Free Grafts.","authors":"Yasunari Hayashi, Takeshi Shimamoto, Satoshi Numata, Yoshihiro Goto, Tatsuhiko Komiya, Hitoshi Yaku, Yasuhide Okawa, Toshiaki Ito","doi":"10.1016/j.athoracsur.2024.09.012","DOIUrl":"10.1016/j.athoracsur.2024.09.012","url":null,"abstract":"<p><strong>Background: </strong>Bilateral internal thoracic artery (ITA) grafting is associated with improved long-term outcomes; however, the appropriate graft configuration remains controversial. We compared the long-term outcomes of different graft configurations.</p><p><strong>Methods: </strong>Between 2009 and 2015, 1171 patients underwent isolated bilateral ITA grafting for left-sided complete revascularization at 4 Japanese cardiac surgery centers: underwent in situ left ITA to the left anterior descending artery plus in situ right ITA to the left circumflex artery (LR group, n = 278), in situ right ITA to the left anterior descending artery plus in situ left ITA to the left circumflex artery (RL group, n = 665), and in situ left ITA to the left anterior descending artery plus free right ITA to the left circumflex artery (free group, n = 228). Major adverse cardiovascular events (MACEs), including mortality, myocardial infarction and revascularization, and ITA patency, were compared.</p><p><strong>Results: </strong>Among the 3 groups, the free group showed significantly lower MACEs and overall mortality rates (P < .001). Nonfatal myocardial infarction and revascularization rates showed no marked differences among the groups. A weighted analysis revealed a decreased risk of MACEs and death in the free group. No marked difference was observed in the patency of the ITA anastomosed to the left anterior descending artery. Patency of the ITA grafted to the circumflex artery in the LR group was significantly lower relative to the other groups. Using a free right ITA grafted to the circumflex artery reduced the risk of graft failure.</p><p><strong>Conclusions: </strong>The free right ITA configuration for left-sided revascularization might have better long-term outcomes and significantly better patency than other grafts.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":"351-360"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309051","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}