Annals of Thoracic Surgery最新文献

{"title":"The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2024 Update on National Trends and Outcomes.","authors":"Alexander Iribarne, Brittany Zwischenberger, James Mehaffey, Tsuyoshi Kaneko, Moritz C Wyler von Ballmoos, Jeffrey P Jacobs, Carole Krohn, Robert H Habib, Niharika Parsons, Vinay Badhwar, Michael E Bowdish","doi":"10.1016/j.athoracsur.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.011","url":null,"abstract":"<p><p>The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is the most robust and advanced clinical database in cardiac surgery. With over 8.3 million procedures and over 1,000 participating institutions encompassing more than 97% of cardiac surgery in the United States, the ACSD is the specialty's vital instrument for quality improvement, patient safety, and outcome reporting in cardiac surgery. The database continues to advance initiatives to achieve these goals, which recently have included adding new risk models for multi-valve procedures, isolated tricuspid valve surgery, aortic valve replacement after transcatheter aortic valve replacement, and mitral valve surgery for degenerative mitral regurgitation. In addition, the ACSD can now provide longitudinal survival through linkage to the National Death Index. This paper reviews current trends in the ACSD through the end of 2023, impactful research during the past year, and database innovations being implemented.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702043","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":"Could Enhanced Cardiac Output Be the Key to Renal Protection Following Amino Acid Infusion in Cardiac Surgery Patients?","authors":"Amr Salah Omar, Ala Rahhal, Samy Hanoura","doi":"10.1016/j.athoracsur.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.007","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694356","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":"Society Board","authors":"","doi":"10.1016/S0003-4975(25)00128-6","DOIUrl":"10.1016/S0003-4975(25)00128-6","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 4","pages":"Page A3"},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686199","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":"Clinical N-Staging Subclassification Among Stage III-N2 NSCLC Patients Undergoing Trimodality Therapy: A Good Beginning is Half the Battle.","authors":"Junghee Lee, Yun Soo Hong, Jin Lee, Genehee Lee, Danbee Kang, Jiyoun Park, Yeong Jeong Jeon, Seong-Yong Park, Jong Ho Cho, Yong Soo Choi, Jhingook Kim, Young Mog Shim, Eliseo Guallar, Juhee Cho, Hong Kwan Kim","doi":"10.1016/j.athoracsur.2025.02.026","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.02.026","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer patients with stage III-N2 disease may benefit from the subclassification of nodal involvement before decision-making. We aimed to evaluate whether the clinical N-descriptor subclassification predicts prognostic in patients undergoing trimodality therapy for stage III-N2 non-small cell lung cancer.</p><p><strong>Methods: </strong>Using our institutional registry between 2003 and 2019, we analyzed 899 consecutive patients with stage III-N2 non-small cell lung cancer undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery. We subclassified clinical N2 into cN2a and cN2b based on imaging and histopathologic results. Recurrence-free survival and overall survival were compared by N2 subclassification and separately by histologic type, using competing risks models and Cox proportional hazards models.</p><p><strong>Results: </strong>Using the proposed N subclassification, 503 (56.0%) and 396 (44.0%) patients were categorized as cN2a and cN2b, respectively. During a median follow-up of 53.1 months, 492 patients had recurrence and 477 died. The hazard ratios (HRs) for recurrence comparing cN2b to cN2a after adjusting for age, sex, comorbidities, clinical T category, and histology were 1.22 (95% confidence interval 1.03-1.46). The adjusted HRs for mortality comparing cN2b to cN2a were 1.43 (1.19-1.71). When stratified by histology, cN2b had a higher risk of mortality compared to cN2a in both adenocarcinoma and squamous cell carcinoma.</p><p><strong>Conclusions: </strong>In our study evaluating the IASLC's approach to subclassify the clinical N-descriptor for III-N2 non-small cell lung cancer patients, cN2b had a higher risk of recurrence and mortality compared with cN2a, suggesting that clinical N subclassification may be a valuable predictor for stage III-N2 patients.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694325","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":"Outcomes of Pediatric Cardiac Surgery Patients Treated with ECMO.","authors":"Peter Pastuszko, Michael G Katz, Gaia R Chen, Richard D Mainwaring","doi":"10.1016/j.athoracsur.2025.03.008","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.03.008","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694415","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":"Editor's Choice","authors":"","doi":"10.1016/S0003-4975(25)00129-8","DOIUrl":"10.1016/S0003-4975(25)00129-8","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 4","pages":"Page A4"},"PeriodicalIF":3.6,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686200","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 Novel Clinical Risk Score to Predict Vasoplegia After Adult Cardiac Surgery.","authors":"Travis J Miles, Michael T Guinn, Orlando R Suero, Todd K Rosengart, Marc R Moon, Joseph S Coselli, Ravi K Ghanta, Subhasis Chatterjee","doi":"10.1016/j.athoracsur.2025.02.022","DOIUrl":"10.1016/j.athoracsur.2025.02.022","url":null,"abstract":"<p><strong>Background: </strong>Vasoplegia is a morbid complication after cardiopulmonary bypass. Identifying patients at risk for vasoplegia may improve outcomes, but current assessment tools are limited by highly heterogeneous and static criteria for defining vasoplegia. Using a more rigorous definition, the study investigators developed a risk score that stratifies risk for vasoplegia after cardiopulmonary bypass.</p><p><strong>Methods: </strong>Postoperative data were extracted from electronic health records of adult patients who underwent surgery with cardiopulmonary bypass at Baylor St. Luke's Medical Center (Houston, TX) from 2017 to 2022. Vasoplegia was defined as an hourly average mean arterial pressure ≤65 mm Hg, cardiac index ≥2.2 L/min/m², norepinephrine equivalents ≥0.1 μg/kg/min, and central venous pressure ≤15 mm Hg for at least 1 hour postoperatively. After merging electronic health record data with institutional elements of The Society of Thoracic Surgery registry, regression coefficients of significant variables were used to assign integer points to a risk score that was then internally validated.</p><p><strong>Results: </strong>The overall incidence of postoperative vasoplegia was 16.7%. Vasoplegic patients had higher rates of in-hospital mortality (6.4% vs. 3.0%, p<0.001) and major morbidity (51.5% vs. 23.4%, p<0.001) compared to non-vasoplegic patients. We developed a risk score comprising the independent predictors of vasoplegia. Patients were divided into risk categories according to total score. The probability of vasoplegia was 3.9%, 14.8%, and 34.2% in patients with low, moderate, and high scores, respectively. The risk score performed well on internal validation (C-index: 0.68 [95% CI: 0.64-0.72]).</p><p><strong>Conclusions: </strong>This clinical risk score has the potential to inform clinical decision-making by identifying high-risk patients and enabling timely intervention.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694321","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":"Comparable clinical outcomes between segmentectomy and lobectomy for NSCLC with unsuspected N1/N2: A multicenter real-world data study.","authors":"Tsuyoshi Ryuko, Mikio Okazaki, Toshiharu Mitsuhashi, Ken Suzawa, Kazuhiko Shien, Tsuyoshi Ueno, Toshiya Fujiwara, Mototsugu Watanabe, Hidetoshi Inokawa, Takahiko Misao, Hidejiro Torigoe, Kazuhiro Washio, Hiroyuki Tao, Daisuke Okutani, Makio Hayama, Masashi Uomoto, Eiji Yamada, Shinji Otani, Takeshi Kurosaki, Yuji Yaginuma, Eito Niman, Osamu Kawamata, Hitoshi Nishikawa, Tomoaki Otsuka, Takeshi Yoshikawa, Tatsuro Hayashi, Shinichi Toyooka","doi":"10.1016/j.athoracsur.2025.02.023","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.02.023","url":null,"abstract":"<p><strong>Background: </strong>Segmentectomy for lung cancer has been increasingly performed. However, evidence regarding the necessity of additional surgical resection following the diagnosis of unsuspected N1/N2 lymph node metastasis is limited.</p><p><strong>Methods: </strong>We conducted a multicenter real-world data study of patients with clinically any T and N0 non-small cell lung cancer (NSCLC) who underwent lobectomy or segmentectomy between 2012 and 2021 and were subsequently diagnosed with pathological N1/N2 lymph node metastasis. Patients were categorized into lobectomy and segmentectomy groups. We analyzed overall survival (OS), recurrence-free survival (RFS), cumulative recurrence rates, and recurrence patterns using both unadjusted and propensity score-adjusted cohorts.</p><p><strong>Results: </strong>A total of 736 patients were in the lobectomy group, and 70 in the segmentectomy group. In the unadjusted cohort, segmentectomy patients were older and had lower preoperative percent vital capacity, smaller tumors, and received less postoperative adjuvant chemotherapy. The 5-year OS was significantly worse in the segmentectomy group (P=0.011), with no significant differences in 5-year RFS or cumulative recurrence rates. In the propensity score-adjusted cohort, there were no significant differences in OS, RFS, or recurrence rates; however, the segmentectomy group had a higher rate of local recurrence.</p><p><strong>Conclusions: </strong>In patients with unsuspected N1/N2 NSCLC, analysis using a cohort adjusted for patient background with propensity scores revealed no differences in OS, RFS, or cumulative recurrence rates between segmentectomy and lobectomy. This suggests that additional resection of the remaining segments may not be necessary for these patients. However, the higher rate of local recurrence in the segmentectomy group warrants careful consideration.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694372","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":"Socioeconomic Disparities are Linked to Predictors of Post-Lobectomy Oxygen Dependency.","authors":"Rajika Jindani, Jorge Humberto Rodriguez-Quintero, Tamar Nobel","doi":"10.1016/j.athoracsur.2025.02.025","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.02.025","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674817","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 Lung Transplantation: Feasibility, Initial Experience, and 3-Year Outcomes","authors":"Dominic Emerson MD ,&nbsp;Dominick Megna MD ,&nbsp;Allen A. Razavi MD ,&nbsp;Laura DiChiacchio MD, PhD ,&nbsp;Jad Malas MD ,&nbsp;Reinaldo Rampolla MD ,&nbsp;Joanna Chikwe MD ,&nbsp;Pedro Catarino MD","doi":"10.1016/j.athoracsur.2025.03.005","DOIUrl":"10.1016/j.athoracsur.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Lung transplantation is performed through clamshell or sternotomy incisions, which may contribute to morbidity and limit patient eligibility. Robotic lung transplantation offers a less-invasive alternative, but data informing treatment choice are limited. This study was therefore designed to evaluate midterm outcomes of robotic and minimally invasive lung transplantation.</div></div><div><h3>Methods</h3><div>Consecutive patients undergoing robotic or minimally invasive lung transplant (defined by &lt;6-cm minithoracotomy) from October 2021 to February 2025 were included in a prospective registry. The primary end point was 1-year survival. A linear mixed-effects regression model compared postoperative pulmonary function. Median follow-up time was 1.8 years (interquartile range, 1-4 years).</div></div><div><h3>Results</h3><div>During the study period, 209 lung transplants, including 111 (53.1%) minimally invasive (21 robotic [10%] and 90 nonrobotic [43.1%]), were performed at a single center. Three patients were converted from robotic to nonrobotic approaches. The robotic cohort had similar risk factors and lung allocation scores but longer median waiting list times (50 days vs 22.5 days, <em>P</em> = .02) compared with nonrobotic minimally invasive recipients, and mean ischemic time was 486 minutes vs 406 minutes (<em>P</em> = .02), respectively. There were no significant differences in postoperative ventilator support &lt;48 hours (76.2% vs 75.6%, <em>P</em> = .79), early severe primary graft dysfunction (4.8% vs 8.9%, <em>P</em> = .53), hospital stay (14.1 vs 14.3 days, <em>P</em> = .95), postoperative pulmonary function, or 1-year unadjusted survival (95.0% vs 95.5%, log-rank <em>P</em> = .84) in robotic compared with nonrobotic minimally invasive recipients.</div></div><div><h3>Conclusions</h3><div>This experience with robotic lung transplantation suggests it is associated with midterm outcomes similar to nonrobotic lung transplantation, despite longer ischemic times.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 5","pages":"Pages 1107-1116"},"PeriodicalIF":3.6,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674813","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}