Annals of Thoracic Surgery最新文献

{"title":"Comparative Analysis of Vizient and The Society of Thoracic Surgeons (STS) Performance Ratings in Cardiac Surgery: A Qualitative Review.","authors":"Lucy Nam, Xiu Liu, Ruby Singh, Laura L Collier, Christine N Angelini, Kathleen M Swierzewski, Rajshri M Gartland, Thoralf M Sundt, Jordan P Bloom, David D'Alessandro, David M Shahian, Arminder S Jassar","doi":"10.1016/j.athoracsur.2026.08.005","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.005","url":null,"abstract":"<p><strong>Background: </strong>STS and Vizient each produce rating systems for cardiac surgery performance. At our institution, during a similar timeframe and for nominally similar cohorts, STS ratings indicated exemplary performance while Vizient suggested worse than expected performance. We hypothesized that these discordant quality signals were driven by methodological differences in how each platform defines cohorts, captures data, adjusts risk, and measures outcomes.</p><p><strong>Methods: </strong>We conducted a single-institution, 12-month retrospective comparison of procedures categorized as isolated coronary artery bypass grafting (CABG) by either STS or Vizient. We compared data sources, patient cohort definitions, observation periods, risk modeling, and outcome definitions, and performed chart review of cases unique to either database.</p><p><strong>Results: </strong>STS identified 414 and Vizient 407 patients in their isolated CABG cohorts. Of these, 398 patients were shared, while 16 were unique to STS and 9 to Vizient. STS and Vizient recorded discrepant mortality counts (9 vs 8 deaths, respectively). Chart reviews revealed discordant operative procedure classifications and inconsistent capture of perioperative events between systems. STS relies on audited clinical registry data, clinically-defined patient cohorts and risk factors, peer-reviewed risk models and measures, and multi-year rolling data windows. Vizient uses administrative claims data and associated risk-adjustment variables and outcomes, proprietary methodologies, and shorter reporting cycles.</p><p><strong>Conclusions: </strong>Discordant assessments of cardiac surgery performance by STS and Vizient quality ratings reflect multiple methodological differences. Understanding these differences is essential for assessing the credibility of these two performance rating systems, reconciling conflicting reports, educating hospital leadership and the public, and guiding evidence-based quality improvement.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801293","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":"Executive Summary for The Society of Thoracic Surgeons (STS) / World Society for Pediatric and Congenital Heart Surgery (WSPCHS) / European Congenital Heart Surgeons Association (ECHSA) 2026 (1) Clinical Practice Guidelines on Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot; (2) Expert Consensus Document on Timing, Indications, and Options for Pulmonary Valve Replacement in Children with Repaired Tetralogy of Fallot; and (3) Expert Opinion on The Role of Exercise Testing in Determining Optimal Timing of Pulmonary Valve Replacement in Tetralogy of Fallot.","authors":"Jennifer S Nelson, Awais Ashfaq, James D St Louis, Jimmy C Lu, Elizabeth Stephens, Michael H Kwon, Anna Kamp, Camilla Rossi, Pallavi Sood, Amber D Khanna, Castigliano Bhamidipati, Jeffrey D Zampi, Attilio A Lotto, Christo Tchervenkov, George Sarris, Jeffrey P Jacobs","doi":"10.1016/j.athoracsur.2026.08.002","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.002","url":null,"abstract":"<p><p>Pulmonary valve replacement (PVR) is a common and critical intervention for patients with repaired tetralogy of Fallot (TOF) and clinically significant pulmonary regurgitation. The Society of Thoracic Surgeons (STS) collaborated with The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) and The European Congenital Heart Surgeons Association (ECHSA) to produce three multi-societal evidence-based manuscripts: (1) Clinical Practice Guidelines (CPG) on Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot; (2) Expert Consensus Document (ECD) on Timing, Indications, and Options for Pulmonary Valve Replacement in Children with Repaired Tetralogy of Fallot; and (3) Expert Opinion (\"White Paper\") on The Role of Exercise Testing in Determining Optimal Timing of Pulmonary Valve Replacement in Tetralogy of Fallot. The purpose of this Executive Summary is to summarize the associated consensus-based recommendations from the CPG, consensus-based statements from the ECD, and consensus-based expert opinions from the \"White Paper\". This collection of documents provides an updated framework for decision-making about PVR for patients with repaired TOF. Key considerations include the status of symptoms, ventricular volumes and function, and procedural risks, with emerging evidence supporting tailored strategies of intervention. Future research should focus on comparing timing and long-term outcomes for transcatheter versus open surgical PVR, particularly in pediatric and adolescent populations.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801326","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":"Lung Cancer Risk for Patients Undergoing Cardiac Chest CT: Identification of a New High Risk Population for Lung Cancer Screening.","authors":"Lillian L Tsai, Chinasa Anokwuru, Ntemena Kapula, Judy Fan, Mina Satoyoshi, Bailey Wallen, Mengrui Zhang, Ingrid Luo, Summer Han, Irmina A Elliott, Brandon A Guenthart, Douglas Z Liou, Natalie S Lui, Mark F Berry, Joseph B Shrager, Leah M Backhus","doi":"10.1016/j.athoracsur.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.08.003","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer screening (LCS) rates are low despite expanded eligibility criteria. Many patients receiving cardiac CT scans may also have risk factors for lung cancer. We aimed to identify an opportunity to increase LCS by quantifying this population.</p><p><strong>Methods: </strong>All patients in our healthcare system from January 2011 to December 2023 who received a CT heart or CT angiogram heart were included. Lung cancer rates in this population were assessed. LCS eligibility was determined by USPSTF guidelines.</p><p><strong>Results: </strong>A total of 31,684 patients received cardiac CT scans and 17,232 patients met the study criteria (documented smoking history, age 50-80 years, no prior diagnosis of lung cancer). Based on 2021 USPSTF guidelines, 114 (0.7%) patients were eligible for LCS compared to 0.37% of all patients in our healthcare system. A total of 73 patients undergoing cardiac CT developed a diagnosis of lung cancer. Among those meeting LCS eligibility, 1 (0.8%) developed lung cancer, 7 (6.1%) received a low dose CT, and 21 (18.4%) received a diagnostic chest CT. An additional 72 (0.4%) patients of patients who received a cardiac CT were subsequently diagnosed with lung cancer at a median of 19.8 (5.7, 51.7) months, yet did not meet LCS eligibility.</p><p><strong>Conclusions: </strong>Risk of lung cancer diagnosis among patients receiving cardiac CT scan is significantly higher than that of the general population. However, most of these patients did not qualify for LCS. Advocacy for more complete chest imaging in this population may facilitate identification of lung cancer for early intervention.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801238","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":"Late Outcomes of Postoperative Complete Heart Block After Congenital Heart Surgery: Recovery or Recurrent Heart Block?","authors":"Yangting Gao, Muneaki Matsubara, Doris Kienmoser, Thibault Schaeffer, Kristin Kruse, Teresa Lemmen, Jonas Palm, Andrei Fetcu, Carsten Lennerz, Nicole Piber, Paul Philipp Heinisch, Alfred Hager, Peter Ewert, Jürgen Hörer, Masamichi Ono","doi":"10.1016/j.athoracsur.2026.06.037","DOIUrl":"10.1016/j.athoracsur.2026.06.037","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complete heart block (CHB) constitutes a complication of congenital heart surgery, requiring a permanent pacemaker (PPM). This study aimed to determine the incidence of postdischarge recovery from CHB after PPM implantation and the incidence of recurrent CHB after initial recovery.</p><p><strong>Methods: </strong>The cumulative incidences of recovery from CHB and postdischarge recurrent CHB after 9892 congenital cardiac operations between 2001 and 2024 were analyzed. A Cox regression model was used to identify predictors of recovery from CHB and recurrent CHB.</p><p><strong>Results: </strong>Of 327 patients with CHB, 193 (59.0%) required a PPM within the same hospital stay, and 134 (41.0%) were discharged without a PPM because of complete recovery. Postdischarge recovery of atrioventricular conduction was observed in 32 of 193 (16.6%) patients with a PPM (median period of 3.8 [0.3-6.3] years). The type of recovery included 22 sinus rhythms, 8 first-degree, and 2 second-degree atrioventricular blocks. Postdischarge recurrent CHB requiring PPM was observed in 11 of 134 (8.2%) patients with a median period of 0.6 (0.2-4.7) years. The cumulative incidence of recovery and late PPM implantation at 10 years was 24.2% and 9.5%, respectively. Neonatal operation (hazard ratio [HR], 4.491; P = .018), longer recovery time with an 8-day threshold (HR, 1.107; P = .022), and catheter intervention (HR, 4.587; P = .025) were risk factors for postdischarge recurrent CHB.</p><p><strong>Conclusions: </strong>Our findings support the current class 1 guidelines for pacemaker implantation after 7 days of CHB. Postdischarge recurrent CHB is difficult to predict in individual patients and can be manifested many years postoperatively, supporting lifelong follow-up after congenital heart surgery.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383006","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 Ross Procedure: Determinants of Long-Term Durability.","authors":"Nabil Ajmi, Arman Sarshoghi, Ismail Bouhout, Pierre-Emmanuel Noly, Nancy Poirier, Pierre-Luc Bernier, Walid Ben Ali, Ismail El-Hamamsy, Philippe Demers","doi":"10.1016/j.athoracsur.2026.07.047","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.047","url":null,"abstract":"<p><strong>Background: </strong>Sex-related differences in valvular heart disease are increasingly recognized, yet contemporary Ross procedure literature rarely reports outcomes by sex. Given the marked male predominance in published series, whether outcomes differ by sex remains unknown. This study evaluated sex-specific outcomes following the Ross procedure in a high-volume center.</p><p><strong>Methods: </strong>This retrospective cohort study included adults undergoing pulmonary autograft using a full root technique between 2011 and 2025. Propensity score matching (2:1 male: female) was performed using 24 preoperative variables. Primary outcomes were overall survival and freedom from reintervention. Secondary outcomes included aortic regurgitation (AR ≥ grade 2), pulmonary regurgitation (PR ≥ grade 2), New York Heart Association (NYHA) functional class, and longitudinal echocardiographic changes.</p><p><strong>Results: </strong>Among 816 patients, 512 matched individuals (337 male, 175 female) were analyzed. Early outcomes were similar, including 30-day mortality (0.6% male vs 1.1% female). Estimated ten-year survival was excellent in both groups (96.4% male vs 92.9% female, P=0.410), as were reintervention rates (10-year cumulative incidence 5.0% vs 2.7%, P=0.309). In contrast, females exhibited two-fold higher AR progression (10-year incidence 11.0% vs 20.5%, P=0.005), supported by generalized estimating equations (sex-by-time P=0.039) and Cox regression (adjusted hazard ratio 2.16-3.00). Pulmonary regurgitation progression and autograft/homograft hemodynamics were similar. Females had persistently worse NYHA functional class throughout follow-up.</p><p><strong>Conclusions: </strong>While survival and reintervention rates after the Ross procedure are comparable between sexes, women experience significantly greater aortic regurgitation progression and worse functional status. These findings underscore important sex-specific differences in postoperative remodeling and mid- to long-term outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708310","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 Intact Anterior Pericardium a Factor in RV Function?","authors":"Frank A Baciewicz, Shrikar Modukuri, Shaun Cardozo","doi":"10.1016/j.athoracsur.2026.07.048","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.048","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148698310","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":"Rethinking the approach to outcomes assessment for neonates with congenital diaphragmatic hernia and complex cardiac disease.","authors":"Matthew T Harting, Kylie I Holden, Alexandra K Boyd, Damien J LaPar","doi":"10.1016/j.athoracsur.2026.07.046","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.046","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690216","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":"Dynamic Mechanical Support Pathways in Ischemic Ventricular Septal Defect.","authors":"Zhichao Zhao, Xian Wei","doi":"10.1016/j.athoracsur.2026.07.044","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.044","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690196","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":"Insight into remodeling aortic valve in ascending thoracic aorta pathology.","authors":"Antonio Manenti, Gianluca Pagnoni, Giovanni Coppi, Francesca Coppi","doi":"10.1016/j.athoracsur.2026.07.045","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.045","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690149","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":"In Memoriam: L. Penfield Faber, MD (October 30, 1931-June 32026, ).","authors":"Christopher W Seder, Michael J Liptay","doi":"10.1016/j.athoracsur.2026.07.042","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2026.07.042","url":null,"abstract":"<p><p>Leroy Penfield Faber, MD recently passed at the age of 97 years old. He was a master educator, an early proponent of multidisciplinary cancer care, and instrumental in developing flexile bronchoscopy, stapled bronchial closure, and segmental lung resections for cancer. Dr. Faber leaves behind a specialty that bears his imprint at many levels: in its culture, its standards, its leadership, and in the surgeons he trained.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686634","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}