Annals of Thoracic Surgery最新文献

{"title":"Avoiding the Things That Can Go Bump in the Night After Cardiac Surgery","authors":"Michael C. Grant MD , Rakesh C. Arora MD, PhD","doi":"10.1016/j.athoracsur.2024.09.050","DOIUrl":"10.1016/j.athoracsur.2024.09.050","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 265-267"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512381","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 MD ,&nbsp;Gaetano Paone MD, MHSA ,&nbsp;Robert H. Habib PhD ,&nbsp;Carole Krohn MPH, BSN ,&nbsp;Bruce A. Bollen MD ,&nbsp;Jeffrey P. Jacobs MD ,&nbsp;Michael E. Bowdish MD, MS ,&nbsp;Miklos D. Kertai MD, PhD","doi":"10.1016/j.athoracsur.2024.06.038","DOIUrl":"10.1016/j.athoracsur.2024.06.038","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"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":"Long-Term Survival Benefit of Surgical Atrial Fibrillation Ablation in Mitral Surgery","authors":"Irbaz Hameed MD ,&nbsp;Alexander Iribarne MD, MS","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":"119 2","pages":"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":"Neurocognitive Dysfunction After Short-Duration (<20 Minutes) Hypothermic Circulatory Arrest: Evidence From the GOT ICE Study","authors":"Eilon Ram MD ,&nbsp;Leonard N. Girardi MD","doi":"10.1016/j.athoracsur.2024.10.025","DOIUrl":"10.1016/j.athoracsur.2024.10.025","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 257-258"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631987","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 MD,&nbsp;Kyle W. Blackburn BS,&nbsp;Subhasis Chatterjee MD","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":"119 2","pages":"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":"Impact of Time of Day on Surgical Outcomes After Lung Transplantation (Nighttime Lung Transplant)","authors":"Kukbin Choi MD ,&nbsp;Salah E. Altarabsheh MD ,&nbsp;Sahar A. Saddoughi MD, PhD ,&nbsp;Philip J. Spencer MD ,&nbsp;Brian Lahr MS ,&nbsp;Defne G. Ergi MD ,&nbsp;Erin Schumer MD ,&nbsp;Mauricio A. Villavicencio MD","doi":"10.1016/j.athoracsur.2024.08.013","DOIUrl":"10.1016/j.athoracsur.2024.08.013","url":null,"abstract":"<div><h3>Background</h3><div>Surgical outcomes have been linked to the technical and cognitive abilities of an exhausted surgical team. In parallel, advancements in preservation have led to the proposal of daytime lung transplants. We sought to investigate whether time of day is associated with outcomes in lung transplants.</div></div><div><h3>Methods</h3><div>Data on 30,404 lung transplants from 2005 to 2021 were obtained from the United Network for Organ Sharing database. Patients were categorized based on the time of surgery with early-hours defined as donor cross-clamp between 10 <span>pm</span> and 3 <span>am</span>, and Cox regression models for 90-day and long-term mortality were made to assess the risk according to time of transplant and covariates. Additionally, the Cox modeling was repeated with donor cross-clamp and the estimated reperfusion time of day as continuous functions.</div></div><div><h3>Results</h3><div>Among 30,404 transplants, 20.7% (6295) were performed during early hours. No significant difference was found between the 2 groups in unadjusted 90-day and long-term mortality (log-rank, <em>P</em> = .176 and .363, respectively), and results were unchanged when adjusting for covariates (<em>P</em> = .233 and .738, respectively). However, when examining donor cross-clamp time and reperfusion time as continuous variables in separate multivariable analyses, we observed significant associations with 90-day mortality (<em>P</em> = .002 and .022, respectively). Notably, lower mortality rates were observed for donor clamp-times between 8 <span>am</span> and 1 <span>pm</span> and estimated reperfusion times between 1 <span>pm</span> and 6 <span>pm</span>.</div></div><div><h3>Conclusions</h3><div>Although binary categorizations of the time of day of lung transplants did not show a significant impact on short- or long-term survival, continuous-time analyses demonstrated that certain times during the day were associated with favorable short-term survival.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 423-431"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114519","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 Impact of Regionalization of Thoracic Oncology Surgery","authors":"Jordan Crosina MD ,&nbsp;Frances Wright MD, MEd ,&nbsp;Jonathan Irish MD, MS ,&nbsp;Mohammed Rashid MSPH ,&nbsp;Tharsiya Martin MS ,&nbsp;Dhruvin H. Hirpara MD, MS ,&nbsp;Amber Hunter MBA ,&nbsp;Sudhir Sundaresan MD","doi":"10.1016/j.athoracsur.2024.10.002","DOIUrl":"10.1016/j.athoracsur.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>In 2007, Cancer Care Ontario created Thoracic Surgical Oncology Standards for the delivery of surgery, including lobectomy, esophagectomy, and pneumonectomy. These standards regionalized thoracic surgery into designated centers and mandated physical and human resources. This analysis sought to identify the impact of these standards, hereafter referred to as “regionalization,” on outcomes after thoracic oncology surgery in Ontario, Canada.</div></div><div><h3>Methods</h3><div>This study was a population-level analysis of patients undergoing lobectomy, esophagectomy, or pneumonectomy, and it used multilevel regression models to compare 30- and 90-day mortality and length of stay before, during, and after regionalization. Interrupted time series models were used to assess for an impact of regionalization while controlling for ongoing trends.</div></div><div><h3>Results</h3><div>A total of 22,195 surgical procedures (14,902 lobectomies, 4958 esophagectomies, and 2408 pneumonectomies) were performed within the study period. A total of &gt;99% of cases were performed at a designated center after regionalization. Mean annual volumes per designated center increased after regionalization for lobectomy and esophagectomy and decreased for pneumonectomy. The 30- and 90-day mortality and length of stay improved for lobectomy and esophagectomy over the study period, as did 90-day mortality for pneumonectomy. However, the interrupted time series analysis did not demonstrate any statistically significant effect of regionalization on these outcomes, separate from preexisting trends.</div></div><div><h3>Conclusions</h3><div>Consistent improvements in mortality and length of stay in thoracic surgical oncology occurred on a provincial level between 2003 and 2020, although this analysis does not attribute these improvements to implementation of Thoracic Surgical Oncology Standards including regionalization.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 460-469"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512386","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":"Impact of Nighttime Cardiovascular Intensive Care Unit Staffing on Failure to Rescue and Revenue","authors":"Jin Kook Kang MD ,&nbsp;Sari D. Holmes PhD ,&nbsp;Hannah J. Rando MD ,&nbsp;Ifeanyi D. Chinedozi MD ,&nbsp;Zachary E. Darby MD ,&nbsp;Jessica B. Briscoe MD ,&nbsp;Michael C. Grant MD ,&nbsp;Glenn J.R. Whitman MD","doi":"10.1016/j.athoracsur.2024.10.014","DOIUrl":"10.1016/j.athoracsur.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Failure to rescue (FTR) is mortality after at least 1 postoperative complication. We investigated the impact of nighttime intensivist staffing and FTR after cardiac surgery.</div></div><div><h3>Methods</h3><div>We included patients who underwent cardiac surgery to examine FTR, defined as mortality in those who experienced a Society of Thoracic Surgeons–defined major complication. Era 2 (July 2021-June 2023) and era 1 (July 2016-June 2021) were characterized by the presence and absence of nighttime intensivists staffing, respectively. Complications and FTR rates, daily intensive care unit (ICU) census, and relative value units (RVUs) were compared.</div></div><div><h3>Results</h3><div>Among 5654 patients, 17% (284 of 1661) in era 2 had at least 1 complication vs 19% (769 of 3993) in era 1 (<em>P</em> = .057). Among patients with complications, FTR incidence was 8% (22 of 284) in era 2 vs 19% (145 of 769) in era 1 (<em>P</em> &lt; .001). The daily average ICU census did not change (12.3 in era 2 vs 12.0 in era 1, <em>P</em> = .386). Comparing mean annual RVUs during the 2 fiscal years in era 2 (35,613 per year) with what would have been expected based on the last 2 fiscal years of era 1 (26,744 per year), a significant increase of +8870 per year was observed (95% CI, 3876-13,863, <em>P</em> = .028). Multivariable analyses found no difference in the risk of major complications comparing era 2 vs era 1 (odds ratio, 1.04; 95% CI, 0.89-1.23; <em>P</em> = .602), and a 59% reduction in FTR risk in era 2 vs era 1 (odds ratio, 0.41; 95% CI, 0.25-0.67; <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Nighttime ICU coverage reduced FTR rates in postcardiotomy patients while complication rates and ICU census remained stable. Furthermore, the increase in RVUs suggested an economically sustainable model.</div></div>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 433-440"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559346","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":"Regionalization of Thoracic Surgical Oncology Bears Fruit in Ontario","authors":"Marissa Guo MD,&nbsp;Peter J. Kneuertz MD, FACS","doi":"10.1016/j.athoracsur.2024.11.015","DOIUrl":"10.1016/j.athoracsur.2024.11.015","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 470-471"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755741","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":"Replacement of Chordae Tendineae With Expanded Polytetrafluoroethylene Sutures","authors":"Tirone E. David MD","doi":"10.1016/j.athoracsur.2024.12.001","DOIUrl":"10.1016/j.athoracsur.2024.12.001","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"119 2","pages":"Pages 259-262"},"PeriodicalIF":3.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796530","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}