Annals of Thoracic Surgery最新文献

{"title":"Parenting from the OR: The Unique Challenges and Positive Impacts on Children Raised by Cardiothoracic Surgeon Mothers.","authors":"Tanisha Rajah, Marianna V Papageorge, Sara Sakowitz, Busra Cangut, Rebekah Boyd, Nicole Lin, Madigan Stanley, Daniela Molena, Ammara Watkins, Stephanie G Worrell, Mara B Antonoff","doi":"10.1016/j.athoracsur.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.029","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789296","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":"Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection with Coronary Ostial Involvement.","authors":"Ling-Chen Huang, Ze-Hua Shao, Yang-Xue Sun, Li-Xi Gan, Xiang-Yang Qian, Cun-Tao Yu, Hong-Wei Guo","doi":"10.1016/j.athoracsur.2025.03.025","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.025","url":null,"abstract":"<p><strong>Background: </strong>Acute type A aortic dissection (ATAAD) with coronary ostial involvement poses significant surgical challenges. We describe two surgical approaches to managing coronary involvement and assess their outcomes.</p><p><strong>Methods: </strong>Between January 2019 and December 2023, 617 ATAAD patients with coronary involvement were enrolled. Based on our institutional surgical protocol, 507 patients underwent isolated coronary ostial reconstruction, whereas 110 received protective coronary artery bypass grafting (CABG) following coronary ostial reconstruction or closure in cases of severe coronary involvement (defined as Neri A with >50% ostial margin involvement, Neri B with distal entry, or Neri C). Serious adverse events were defined as operative mortality, mechanical support, or stroke. Logistic regression identified factors associated with serious adverse events.</p><p><strong>Results: </strong>Operative mortality occurred in 23 patients (3.73%), and 44 patients (7.13%) experienced serious adverse events. Despite more severe coronary involvement (P<0.001) and coronary malperfusion (P<0.001) at baseline, the protective CABG group showed significantly lower procedural myocardial injury (2.73% vs. 9.27%, P=0.037) and a trend toward fewer serious adverse events (2.73% vs. 8.09%, P=0.076). Logistic regression identified that protective CABG was associated with a reduced risk of serious adverse events (odds ratio:0.24, 95%confidence interval:0.07-0.86, P=0.028). The median follow-up was 25.95 months. Kaplan-Meier analysis revealed no significant difference in cumulative survival between the two groups (log-rank P=0.70).</p><p><strong>Conclusions: </strong>Our institutional surgical protocol demonstrates safety and effectiveness. The protective CABG approach was associated with a reduced risk of serious adverse events without impacting overall survival, supporting its more aggressive use in ATAAD with severe coronary involvement.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789299","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":"ENLARGEMENT OF THE AORTIC ANNULUS DURING AORTIC VALVE REPLACEMENT: Just a matter of terminology?","authors":"Uberto Bortolotti, Ugolino Livi, Igor Vendramin","doi":"10.1016/j.athoracsur.2025.03.027","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.027","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789254","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":"Definitions of Cardiogenic Shock and Indications for Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.","authors":"Michael C Grant, Charles Scott Brudney, Jaime Hernandez-Montfort, Stephanie O Ibekwe, Amanda Rea, Christian Stoppe, Alexander Zarbock, Andrew D Shaw, Daniel T Engelman, Manreet K Kanwar","doi":"10.1016/j.athoracsur.2025.01.040","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.040","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with cardiogenic shock (CS) is complex and resource-intensive, particularly given the recent surge in temporary mechanical circulatory support (tMCS) devices. This document was created to establish an approach to the assessment of CS to provide early and targeted therapies, including tMCS.</p><p><strong>Methods: </strong>An interdisciplinary, international panel of experts, utilizing a structured appraisal of the literature and a modified Delphi method, derived consensus regarding the assessment of CS based on pathophysiologic severity, etiology, and phenotypic clustering to guide escalation of care as well as identify those patients who might benefit from tMCS.</p><p><strong>Results: </strong>Key principles included early and continuous assessment for the evolution of shock severity to guide the escalation of care as well as establishment of the cause of CS to facilitate triage and assignment of initial therapies. Phenotypic clustering is complementary and aids in prognosis. tMCS provides the greatest benefit in CS for relief of congestion refractory to medical therapy, ideally when initiated before the development of organ injury. The use of tMCS should be preceded by an interdisciplinary discussion as part of the informed consent process to establish therapeutic goals, including exit strategies.</p><p><strong>Conclusions: </strong>Based on the available literature and expert consensus, there is an opportunity to further standardize the approach to CS, including characterization based on the severity of the shock state, etiology, and further enhancement by phenotyping. Monitoring, early triage and timely escalation of care, including the targeted initiation of tMCS, can minimize organ injury and in-hospital mortality.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789198","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":"Temporary Mechanical Circulatory Support in Cardiogenic Shock: Executive Summary of the Joint Consensus Reports of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.","authors":"Michael C Grant, Manreet K Kanwar, Audrey E Spelde, Subhasis Chatterjee, Jean Deschamps, Rakesh C Arora, Andrew D Shaw, Daniel T Engelman","doi":"10.1016/j.athoracsur.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.024","url":null,"abstract":"<p><strong>Background: </strong>The identification, triage, and management of cardiogenic shock (CS) is complex and resource-intensive, particularly given the recent surge in the use of temporary mechanical circulatory support (tMCS) devices. This document is an executive summary of a series of consensus statements which guide the bedside clinician regarding the management of tMCS in the setting of CS.</p><p><strong>Methods: </strong>The PeriOperative Quality Initiative (POQI) and Enhanced Recovery After Surgery (ERAS®) Cardiac Society convened an interdisciplinary, international panel of experts, utilized a structured appraisal of the literature and the modified Delphi method to derive consensus on a series of topics related to both CS and tMCS.</p><p><strong>Results: </strong>The effort resulted in three manuscripts with guidance related to the diagnosis, escalation/de-escalation and best practices associated with CS and the provision of tMCS. Group consensus was derived around existing clinical questions, summary guidance statements and the quality of the existing evidence.</p><p><strong>Conclusions: </strong>The POQI/ERAS Cardiac consensus series derived 27 unique statements regarding the care of patients with CS and the provision of tMCS. Key themes emerged, including the need for immediate and systematic assessment of CS severity, early initiation of tMCS, an algorithmic approach to the escalation and de-escalation of tMCS therapies and adoption of high-quality best practices associated with tMCS management.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789300","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":"An unresolved surgical conundrum: How to manage unsuspected nodal involvement in early-stage lung cancer.","authors":"Valerie W Rusch","doi":"10.1016/j.athoracsur.2025.03.021","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.021","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788976","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":"Patient Selection for Surgery vs. Surveillance in Moderately Dilated Ascending Aorta: A Plea for Patient-Centered Considerations.","authors":"Armin Darius Peivandi, Andreas Martens, Angelo Maria Dell'Aquila","doi":"10.1016/j.athoracsur.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.026","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789297","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":"Physician-Modified Fenestrated and Branched Endografts: A Critical Solution in the Desert of Commercial Devices.","authors":"Chandler A Long","doi":"10.1016/j.athoracsur.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.022","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789298","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":"Is Clinical Staging of Patients with N2 Disease Into N2a and N2b Relevant?","authors":"Benny Weksler","doi":"10.1016/j.athoracsur.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.023","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789295","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":"Beyond Zone 0 in Acute DeBakey Type I Aortic Dissection.","authors":"Selim Mosbahi, Nimesh D Desai","doi":"10.1016/j.athoracsur.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.020","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755622","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}