Annals of Thoracic Surgery最新文献

{"title":"Exercise performance and right ventricular remodeling following the Cone repair in patients with different severity of Ebstein´s anomaly.","authors":"Melchior Burri, Nicole Nagdyman, Lina Hock, Christian Meierhofer, Julia Hock, Julie Cleuziou, Rüdiger Lange","doi":"10.1016/j.athoracsur.2025.04.037","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.037","url":null,"abstract":"<p><strong>Background: </strong>While the Cone repair has shown good outcome regarding valve competence, its effect on exercise performance and right ventricular remodelling are unclear.</p><p><strong>Methods: </strong>Between 01/2010 and 06/2021, 60 patients underwent a Cone repair at our centre. We excluded patients with previous operation (n=6), age<5 years (n=3), in-hospital-death (n=2), replacement before discharge (n=1) and missing follow-up (n=2), resulting in a study-population of 46 patients. Median age was 27 years [range: 5.6-68.2], 28 (61%) were female. Patients were divided based on indication: (A) patients in NYHA I-II without findings of severe/progressed disease (B), patients in NYHA I-II and findings of severe/progressed disease in MRI or Spiroergometry, and (C) patients in NYHA III-IV.</p><p><strong>Results: </strong>Follow-up was 6.7±3.7years. Tricuspid regurgitation at last follow-up was none-mild in 40 patients, moderate in five, and severe in one patient, who underwent reoperation after 5.7years. NYHA class improved in 18 patients, stayed equal in 24 and worsened in four (p=0.002). CPET showed no difference between preoperative and postoperative exercise-capacity (preoperative: 72% of predicted vs. postoperative: 71%, p=1.0). Exercise-capacity improved only in group C. RV-EDVI decreased from 166ml/m2 to 114ml/m2 (p<0.001), the reduction was smaller in group A (-13%) compared to group B and C (-23% and -53%). Antegrade stroke-volume increased in every group (preoperative: 55ml, postoperative: 72ml, p=0.005).</p><p><strong>Conclusions: </strong>The Cone repair results in a substantial and sustained decrease in tricuspid valve regurgitation. While objective exercise capacity did not improve, NYHA class improvement, right ventricle size decreased and antegrade stroke volume increased.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095531","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":"A Multi-Institutional Study on the Prevalence and Clinical Impact of Patient-Prosthesis Mismatch in Surgical Aortic Valve Replacement.","authors":"Lucy Nam, Ruby Singh, Sameer A Hirji, Vivian Nguyen, Asishana A Osho, Arminder S Jassar, Sary F Aranki, David A D'Alessandro, Thoralf M Sundt, Jordan P Bloom","doi":"10.1016/j.athoracsur.2025.04.036","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.036","url":null,"abstract":"<p><strong>Background: </strong>Prosthesis-patient mismatch (PPM) impacts surgical aortic valve replacement outcomes, with known associations with adverse clinical consequences. However, contemporary understanding of PPM's clinical implications, trends, and predictive factors remains limited.</p><p><strong>Methods: </strong>This multi-institutional study included all patients undergoing surgical aortic valve replacement between 2002-2023. PPM was calculated using effective orifice area indexed to body surface area (EOAi), categorized as moderate (EOAi ≤0.85 cm²/m²) or severe (EOAi ≤0.65 cm²/m²), with modified criteria for patients with body mass index ≥30 kg/m² per Valve Academic Research Consortium 3 guidelines. Clinical outcomes and predictors were assessed using Kaplan-Meier and multivariable analysis.</p><p><strong>Results: </strong>Among 10,607 surgical aortic valve replacement patients, 8,102 (76%) had no PPM, 2,333 (22%) had moderate PPM, and 172 (2%) had severe PPM. PPM prevalence declined over the last decade (31% to 18%, P<0.05), coinciding with larger prosthetic valves (size 23±2 to 24±2, P<0.05), and increased annular enlargement (2.4% to 6.0%, P<0.05). PPM was associated with higher 30-day mortality (OR 1.46, 95% CI 1.13-1.88, P<0.05) and reduced long-term survival. Age-sex stratified analysis revealed a stronger association between advanced age and PPM risk in females compared to males (OR 2.31 vs 1.66 for age >74 vs <65, both P<0.05).</p><p><strong>Conclusions: </strong>While PPM prevalence has declined through technical improvements and evolving patient selection, it remains a significant predictor of adverse outcomes. The pronounced risk in older female patients highlights the need for targeted surgical strategies, including careful prosthesis selection and consideration of annular enlargement in high-risk groups.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095525","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":"Safety and Feasibility of Novel Single-Port Robotic-Assisted Lobectomy/Segmentectomy for Lung Cancer.","authors":"Hengrui Liang, Wei Wang, Man Zhang, Runchen Wang, Shunjun Jiang, Fuhao Xu, Chao Yang, Jun Huang, Shuben Li, Zeyong Zhang, Weisen Wu, Diego Gonzalez-Rivas, Jianxing He","doi":"10.1016/j.athoracsur.2025.04.035","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.035","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted thoracic surgery (RATS) has advanced lung cancer treatment with precise robotic arm maneuvers and 3D visualization. While conventional RATS systems require multiple incisions, a uniportal approach is increasingly favored. However, current systems face challenges with maneuverability and incision size. The SHURUI SP robotic system, with its total-flex single-arm design, addresses these limitations, especially for patients with narrow intercostal spaces or limited intrathoracic space.</p><p><strong>Methods: </strong>This phase I/II single-arm registry trial assessed the safety and feasibility of lobectomy/segmentectomy using the SHURUI SP robotic system. The study enrolled patients aged 18-75 with lung cancer from November 2023 to April 2024. The SHURUI single portal (SP) system's \"deformable dual continuum mechanism\" technology enabled precise surgical maneuvers, evaluating primary endpoints like conversion rates, blood loss, lymph node retrieval, transfusion needs, and intraoperative complications.</p><p><strong>Results: </strong>Thirty-five patients, median age 58, underwent lobectomy/segmentectomy, with successful procedures in all cases. No conversions to video-assisted thoracic surgery or open surgery were needed, and no additional trocars were used. Median operative time was 155 minutes, docking time 3 minutes, and console time 81 minutes. Median blood loss was 10 mL, with no transfusions required. The 30-day morbidity rate was 11.43%, with no major complications or rehospitalizations. All patients were discharged after a mean hospital stay of 4 days.</p><p><strong>Conclusions: </strong>The SHURUI SP robotic system demonstrates safety and feasibility for RATS in lung cancer. A large-scale, multicenter randomized controlled trial is needed to further validate this technology's efficacy and safety across a broader patient population.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095535","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":"Optimizing Blood Pressure and Heart Rate Control in the Long Run.","authors":"Feng-Cheng Chang, Shao-Wei Chen","doi":"10.1016/j.athoracsur.2025.04.032","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.032","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081929","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":"Surgical Aortic Valve Replacement in Low-Risk Patients: Methodological Considerations from PARTNER 3.","authors":"Taha Bhatti","doi":"10.1016/j.athoracsur.2025.04.033","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.033","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081931","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":"Unilateral vs. Bilateral Lung Transplantation Following Ex Vivo Lung Perfusion.","authors":"Divyaam Satija, Martin Walsh, Theodore Dimitrov, Vivienne Pham, Ervin Y Cui, Ammu V Alvarez, Kukbin Choi, Matthew C Henn, Nahush A Mokadam, Bryan A Whitson, Doug A Gouchoe, Asvin M Ganapathi","doi":"10.1016/j.athoracsur.2025.04.030","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.030","url":null,"abstract":"<p><strong>Background: </strong>Ex vivo lung perfusion (EVLP) has increased, but a knowledge gap in outcomes of unilateral and bilateral lung transplantation following EVLP exists.</p><p><strong>Methods: </strong>Lung transplants following EVLP were identified from the United Network for Organ Sharing Database from 2/28/2018-3/31/2024. Recipients were stratified into unilateral and bilateral lung transplant. Multivariable logistic regression was used to identify factors associated with unilateral lung transplant. Propensity score matching was used to balance recipient/donor baseline characteristics. Comparative statistics were used to assess post-operative outcomes between the groups.</p><p><strong>Results: </strong>There were 534 recipients identified in bilateral and 84 in the unilateral group. Factors associated with unilateral transplantation included increased recipient/donor age, and recipient diagnoses of restrictive lung disease/pulmonary vascular disease, while increased pulmonary artery pressure and female donor gender were associated with bilateral transplant. Prior to matching, the bilateral group had significantly longer perfusion times, length of stay, and prolonged intubation (5+ days) rates. Unadjusted mid-term survival did not differ significantly between groups (p=0.88). Following matching, bilateral recipients had significantly longer perfusion times, length of stay, and higher prolonged intubation rates, but no differences in other post-operative outcomes. Adjusted mid-term survival did not differ significantly either (p=0.79). Comparison of unilateral transplants with/without EVLP revealed similar results between groups.</p><p><strong>Conclusions: </strong>Following EVLP, bilateral recipients had significantly increased length of stay and rates of prolonged intubation, however, mid-term survival did not significantly differ between ULT and BLT recipients. These findings suggest that EVLP can be safely employed for unilateral lung transplantation in appropriately selected recipients.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081932","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":"High catchment areas for lung cancer screening-eligible patients.","authors":"Madeline Kaltman, Sriya Yalamanchili, Ju Ae Park, Michael J Weyant, Kei Suzuki","doi":"10.1016/j.athoracsur.2025.04.029","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.029","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer screening (LCS) via low-dose CT (LDCT) is an underutilized preventative tool. To target LCS resources, we aimed to determine which departments LCS-eligible patients had the most frequent encounters in a large health system.</p><p><strong>Methods: </strong>We queried our electronic medical records by age (50 and above) and smoking status between 1/1/2021 and 5/31/2022 within our hospital system (n=62,630). We randomly reviewed every 20 charts (n=3,704) for LCS eligibility. Medical record numbers were used to track encounters with departments and service lines and to determine if LDCT was done. Chi-square test was used to test differences in department utilization by demographics and differences in LDCT uptake by department.</p><p><strong>Results: </strong>Of the 3,704 patients assessed, we identified 460 LCS-eligible patients. Of the 460 LCS-eligible patients, the mean age was 64 ± 8 with 201 females (44%). The study population comprised 328 white (71%), 54 black (12%), and 25 Asian (5%) and 54 Hispanic (12%). The most visited departments by the LCS-eligible patients were emergency department (225, 49%), cardiology (202, 44%), the pre-operative service line (179, 39%), and orthopedics (63, 14%). There was no difference in department utilization by sex, race, or ethnicity (p>0.05). Overall LCS uptake was 17.2% (79/460), and there was no significant difference by visited departments.</p><p><strong>Conclusions: </strong>The emergency room, cardiology, and pre-operative clinics were the most common locations for encounters by LCS-eligible patients. Our study helps identify clinics in which we will plan to focus interventions to improve LCS uptake.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081928","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":"Robotic Cardiac Surgery Training Curriculum.","authors":"David Blitzer, Michael Lalonde, Michael Argenziano, Arnar Geirsson","doi":"10.1016/j.athoracsur.2025.04.034","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.034","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081930","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":"Valuing Large Scale Data.","authors":"J Hunter Mehaffey, Ali Darehzereshki, Vinay Badhwar","doi":"10.1016/j.athoracsur.2025.04.031","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.031","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081933","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":"Association Between Left Ventricular Assist Device Infections and Number of Shared Patients Among Care Providers: A Network Analysis.","authors":"Robert B Hawkins, James W Stewart, K Dennie Kim, Hechuan Hou, Michael J Pienta, Russell Funk, Thomas M Cascino, Keith D Aaronson, Preeti N Malani, Lourdes Cabrera, Francis D Pagani, Donald S Likosky","doi":"10.1016/j.athoracsur.2025.04.028","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.04.028","url":null,"abstract":"<p><strong>Background: </strong>For patients on durable left ventricular assist devices (LVAD), prior work has documented that more shared patients among clinicians (connectedness) is associated with improved long-term outcomes. This study examines the association between pre-admission clinician connectedness, patient acuity and post-implant outcomes including infections.</p><p><strong>Methods: </strong>The Society of Thoracic Surgeons Intermacs National Database was linked to Medicare claims to identify patients undergoing durable LVAD implantation between 2009-2017. Patients were stratified by terciles (low, moderate, high) of provider connectedness. The association between provider connectedness and major infections within 180 days of implant was evaluated by regression analysis, with an interaction term to assess effect modification by patient acuity via INTERMACS Patient Profile.</p><p><strong>Results: </strong>Of the 4,985 patients across 127 hospitals, those within networks of low versus high provider connectedness were more commonly INTERMACS Profile 1 (12.6% vs. 6.7%, p<0.001), and designated for destination therapy (3.4% vs. 0.7%, p=0.002). Patients cared for in centers with high connectedness had a lower risk of infection (β=-0.100, p=0.026) and fewer total infections (β= -0.215, p=0.014). The risk of infection was most pronounced in higher acuity INTERMACS Profile 1 patients (p=0.006).</p><p><strong>Conclusions: </strong>Patients in networks with lower clinician connectedness (fewer shared patients) presented with higher acuity. After adjusting for pre-implantation risk, lower clinician connectedness was associated with an increased risk of major infections, particularly among high-acuity patients. Measuring and improving network connectedness may be an important quality metric for timely access to advanced heart failure treatment and reducing complications.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025393","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}