Annals of Thoracic Surgery最新文献

{"title":"National Outcomes of Cardiac Surgery in Patients Receiving Kidney Replacement Therapy.","authors":"Dominic Keuskamp, Christopher E Davies, Robert A Baker, Kevan R Polkinghorne, Christopher M Reid, Julian A Smith, Lavinia Tran, Jenni Williams-Spence, Rory Wolfe, Stephen P McDonald","doi":"10.1016/j.athoracsur.2024.09.048","DOIUrl":"10.1016/j.athoracsur.2024.09.048","url":null,"abstract":"<p><strong>Background: </strong>Studies estimating risks after cardiac surgery for patients receiving kidney replacement therapy have been limited by the size and generalizability of those cohorts. This study used data linked between registries to estimate short-term postoperative outcomes for large patient cohorts receiving kidney replacement therapy at the time of surgery.</p><p><strong>Methods: </strong>This population-based observational cohort study included adult patients who had undergone cardiac surgery in Australia between 2010 and 2019. Patient data were linked with a kidney replacement therapy registry to identify cohorts accurately and extract relevant data. Multivariable logistic regression estimated the risk of operative (30-day) mortality and other postoperative outcomes for long-term dialysis and functioning kidney transplant cohorts compared with each other and the general cardiac surgical population.</p><p><strong>Results: </strong>Of 114,496 surgeries, 1241 were in patients receiving long-term dialysis and 298 for those with a kidney transplant. The mortality rate was highest for patients who had valve-with-coronary artery bypass grafting for patients undergoing dialysis (18.78 per 100 surgeries; 95% CI, 13.37-25.25) and transplant recipients (14.00 per 100 surgeries; 95% CI, 5.82-26.74). Dialysis-treated patients had higher adjusted odds of mortality (odds ratio [OR], 4.17; 95% CI, 3.31-5.25) and all other measured outcomes than did the general population. Kidney transplant recipients had similarly elevated odds of mortality (OR, 3.52; 95% CI, 2.16-5.72).</p><p><strong>Conclusions: </strong>Despite the younger age of the dialysis and transplant cohorts at surgery, operative mortality rates were higher, and the mortality rates for valve-with-coronary artery bypass grafting were 3.7- to 5-fold higher than those in the general population. Patients undergoing dialysis were a high risk for cardiac surgery, and the prognosis for kidney transplant recipients was similarly poor.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480076","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":"Survival Outcomes of Neoadjuvant Therapy Followed by Sleeve Lobectomy in Non-Small Cell Lung Cancer.","authors":"Xiang Li, Qiuyuan Li, Fujun Yang, Erji Gao, Lei Lin, Yaqiang Li, Xuefei Hu, Xiao Song, Liang Duan","doi":"10.1016/j.athoracsur.2024.09.043","DOIUrl":"10.1016/j.athoracsur.2024.09.043","url":null,"abstract":"<p><strong>Background: </strong>This study was carried out to evaluate the impact of neoadjuvant therapy on long-term survival of patients with non-small cell lung cancer undergoing sleeve lobectomy.</p><p><strong>Methods: </strong>A total of 613 patients were retrospectively analyzed, including 124 who received neoadjuvant therapy. A 1:2 propensity score matching method was adopted to create a balanced cohort including 110 with neoadjuvant therapy and 169 without neoadjuvant therapy. Survival was estimated by the Kaplan-Meier method and compared with the log-rank test and Cox proportional hazards models.</p><p><strong>Results: </strong>Neoadjuvant therapy was associated with improved 3-year disease-free survival (DFS; 73.6% vs 54.4%; P < .001) and overall survival (OS; 80.9% vs 63.9%; P = .002) compared with patients without neoadjuvant therapy. Moreover, neoadjuvant chemoimmunotherapy significantly improved 3-year DFS (85.3% vs 54.4%; P = .001) and OS (88.2% vs 63.9%; P = .006), whereas chemotherapy alone did not show a significant effect. Multivariable Cox regression analysis revealed neoadjuvant therapy to be an independent predictor of improved DFS and OS, whereas pathologic N2 stage was independently associated with poorer DFS and OS. Furthermore, subgroup analysis in the neoadjuvant arm revealed that pathologic N2 stage is an independent risk factor for DFS (hazard ratio, 3.830; 95% CI, 1.687-8.694; P = .001), and achieving major pathologic response is an independent predictor for better OS (hazard ratio, 0.120; 95% CI, 0.015-0.933; P = .043).</p><p><strong>Conclusions: </strong>Neoadjuvant therapy before sleeve lobectomy significantly increased DFS and OS in locally advanced non-small cell lung cancer. Sleeve lobectomy is advisable after neoadjuvant therapy, especially following chemoimmunotherapy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480079","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":"Factors Associated With Permanent Pacemaker Placement After Tricuspid Valve Operations.","authors":"Salman Zaheer, Sari D Holmes, Emily Rodriguez, Nolan M Winicki, Emily Larson, Rachael Quinn, Gorav Ailawadi, A Marc Gillinov, James S Gammie","doi":"10.1016/j.athoracsur.2024.09.042","DOIUrl":"10.1016/j.athoracsur.2024.09.042","url":null,"abstract":"<p><strong>Background: </strong>Conduction abnormalities requiring permanent pacemaker (PPM) implantation are common after tricuspid valve operations, although the incidence is variable. This study investigated contemporary rates of and risk factors for a PPM after tricuspid operations.</p><p><strong>Methods: </strong>The Society of Thoracic Surgeons Adult Cardiac Surgery Database was used to identify patients with tricuspid repair or replacement from 2011 to 2020. Factors independently associated with the risk of a postoperative PPM during the index hospital admission were examined using multivariable logistic regression with a complete case approach. Annualized hospital and surgeon volumes were calculated.</p><p><strong>Results: </strong>We identified 71,937 patients undergoing tricuspid operations. Median patient age was 66 years (interquartile range, 53-74 years), 56% (n = 40,590) were women, and the median ejection fraction was 0.56 (interquartile range, 0.48-0.60). Tricuspid operations were concomitant in 87% (n = 62,457), elective in 62% (n = 44,393), and included repair in 86% (n = 61,720). Overall postoperative incidence of a PPM was 15% (n = 10,857); 13% (n = 8304) after repair and 25% (n = 2553) after replacement; and 4% (n = 174) for isolated tricuspid repair and 24% (n = 1248) for isolated tricuspid replacement. Multivariable analysis showed baseline characteristics, endocarditis, concomitant operations, longer cardiopulmonary bypass time, tricuspid replacement, and lower hospital and surgeon tricuspid operative volumes were independently associated with greater risk for a PPM. After adjustment, tricuspid replacement had 3.2-times greater PPM risk compared with tricuspid repair.</p><p><strong>Conclusions: </strong>Nationally, 15% of patients undergoing tricuspid operations required postoperative PPM implantation. PPM risk was increased with concomitant valve operations, tricuspid replacement, longer cardiopulmonary bypass time, and operations performed by less experienced surgeons and centers. Innovation is needed to decrease this significant morbidity.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480073","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":"Gastroesophageal Reflux Disease: Do We Have More Durable Long-term Options?","authors":"Carolyn Chang MD,&nbsp;Stephanie G. Worrell MD","doi":"10.1016/j.athoracsur.2024.09.039","DOIUrl":"10.1016/j.athoracsur.2024.09.039","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"118 6","pages":"Pages 1214-1215"},"PeriodicalIF":3.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480074","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 Expert Consensus on the Multidisciplinary Management and Resectability of Locally Advanced Non-small Cell Lung Cancer.","authors":"Samuel S Kim, David T Cooke, Biniam Kidane, Luis F Tapias, John F Lazar, Jeremiah W Awori Hayanga, Jyoti D Patel, Joel W Neal, Mohamed E Abazeed, Henning Willers, Joseph B Shrager","doi":"10.1016/j.athoracsur.2024.09.041","DOIUrl":"10.1016/j.athoracsur.2024.09.041","url":null,"abstract":"<p><strong>Background: </strong>The contemporary management and resectability of locally advanced lung cancer are undergoing significant changes as new data emerge regarding immunotherapy and targeted treatments. The objective of this document is to review the literature and present consensus among a group of multidisciplinary experts to guide the determination of resectability and management of locally advanced non-small cell lung cancer (NSCLC) in the context of contemporary evidence.</p><p><strong>Methods: </strong>The Society of Thoracic Surgeon Workforce on Thoracic Surgery assembled a multidisciplinary expert panel composed of thoracic surgeons and medical and radiation oncologists with established expertise in the management of lung cancer. A focused literature review was performed, and expert consensus statements were developed using a modified Delphi process to address 3 major themes: (1) assessing resectability and multidisciplinary management of locally advanced lung cancer, (2) neoadjuvant (including perioperative) therapy, and (3) adjuvant therapy.</p><p><strong>Results: </strong>A consensus was reached on 19 recommendations. These consensus statements reflect updated insights on resectability and multidisciplinary management of locally advanced lung cancer based on the latest literature and current clinical experience, mainly focusing on the appropriateness of surgical therapy and emerging data regarding neoadjuvant and adjuvant therapies.</p><p><strong>Conclusions: </strong>Despite the complex decision-making process in managing locally advanced lung cancer, this expert panel agreed on several key recommendations. This document provides guidance for thoracic surgeons and other medical professionals in the optimal management of locally advanced lung cancer based on the most updated evidence and literature.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480081","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":"Aortic Valve Neocuspidization: An Additional Asset in the Lifetime Management of Aortic Valve Diseases.","authors":"Andrea Amabile, Markus Krane, Danny Chu","doi":"10.1016/j.athoracsur.2024.09.045","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.045","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480069","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 Critical Role of Mitral Regurgitation Etiology in TAVR.","authors":"Irbaz Hameed, J Hunter Mehaffey","doi":"10.1016/j.athoracsur.2024.09.047","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.047","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480080","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 multi-arterial bypass graft: Need for quality RCTs to evaluate elaborate operative characteristics.","authors":"Mana Jameie, Mina Pashang, Kiomars Abbasi, Kaveh Hosseini, Mario Gaudino","doi":"10.1016/j.athoracsur.2024.09.046","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.046","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480078","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":"Cardiothoracic Surgery Salary Discrepancies between Races and Ethnicities.","authors":"Zamaan Hooda, Mara B Antonoff","doi":"10.1016/j.athoracsur.2024.09.044","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2024.09.044","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480071","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":"Cardiac Donation After Circulatory Death: Teasing Out the Details","authors":"Laura DiChiacchio MD, PhD ,&nbsp;Akbarshakh Akhmerov MD ,&nbsp;Dominic Emerson MD","doi":"10.1016/j.athoracsur.2024.09.040","DOIUrl":"10.1016/j.athoracsur.2024.09.040","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":"118 6","pages":"Page 1176"},"PeriodicalIF":3.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480070","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}