Annals of Thoracic Surgery最新文献

{"title":"Mechanical Valves vs Bioprostheses: A Call to Reevaluate Our Biases and Commit to Data-Driven Valve Strategies.","authors":"Joseph A Dearani, Rick Nishimura, Ulrik Sartipy, Hartzell V Schaff","doi":"10.1016/j.athoracsur.2025.02.008","DOIUrl":"10.1016/j.athoracsur.2025.02.008","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537889","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":"2514 Cases of Thoracoabdominal and Descending Thoracic Aorta Surgery: Strategies Associated With Improved Survival, Stroke, and Paraplegia.","authors":"Sung Jun Park, Tae Hyun Park, Yejee Kim, Sehee Kim, Ho Jin Kim, Hee Jung Kim, Dae-Hee Kim, Joon Bum Kim","doi":"10.1016/j.athoracsur.2025.02.005","DOIUrl":"10.1016/j.athoracsur.2025.02.005","url":null,"abstract":"<p><strong>Background: </strong>Despite the remarkable outcome of open thoracoabdominal aortic repairs of high-volume aortic centers, generalized results that span diverse clinical settings are needed in the era of thoracic endovascular aortic repair. This study explored national real-world data focusing on the impact of cumulative surgical volume on the operative outcomes.</p><p><strong>Method: </strong>Data from the Korean National Health Insurance Service claims database were used to create a cohort that included adult patients who underwent open thoracoabdominal or descending thoracic aortic aneurysm repairs from 2008 to 2020. The primary outcome was operative mortality defined as 30-day mortality or in-hospital mortality. The secondary outcome was adverse early outcome defined as a composite measure of operative mortality, stroke, and spinal cord injury.</p><p><strong>Results: </strong>The study included 2514 patients (mean age, 60.7 years; 615 women [24.5%]). Distribution of cases revealed a pronounced bias toward a limited number of larger centers: 1724 operations (68.6%) were concentrated in 6 highest-volume centers. Operative mortality rates decreased with increasing surgical volume: 30.1% in institutions with <50 cases, 20.6% for 50 to 99, 15.0% for 100 to 299, and 10.5% for those with ≥300 cases (P < .001). Multivariable analyses further revealed that higher hospital volume was associated with lower risks of operative mortality and adverse early outcomes.</p><p><strong>Conclusions: </strong>The early operative outcomes of open thoracoabdominal aortic aneurysm repairs were significantly influenced by the institutional volume of the operating centers, highlighting the indispensable role of experience and expertise. This suggests the strategic aggregation of cases toward specialized, high-volume centers to optimize surgical results.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537564","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":"Evaluation of Uncertain Resection for Localized Non-small Cell Lung Cancer: The Crucial Prognosis of Suboptimal Lymph Node Assessment.","authors":"Romain Vergé, Axel Rouch, Pierre Rabinel, Claire Renaud, Mathilde Cazaux, Laurent Brouchet","doi":"10.1016/j.athoracsur.2025.02.004","DOIUrl":"10.1016/j.athoracsur.2025.02.004","url":null,"abstract":"<p><strong>Background: </strong>Surgery is the cornerstone of treatment for early-stage non-small cell lung cancer (NSCLC). The concept of \"uncertain resection\" (R[un]) describes cases where complete tumor excision with clear margins is achieved but without comprehensive lymph node assessment or pleural cytology. This study aimed to establish R(un) as a prognostic factor in localized NSCLC patients and explore its heterogeneity.</p><p><strong>Methods: </strong>This single-center retrospective study was conducted at Toulouse University Hospital. Consecutive patients who underwent surgery for localized NSCLC between 2008 and 2018 were included. Resection status, particularly R(un), was reclassified retrospectively. Overall survival and disease-free survival were analyzed, and a Cox proportional hazards regression model was used to assess whether R(un) and its newly proposed subcategories were independent predictors of survival.</p><p><strong>Results: </strong>Among 1108 patients, 732 (66.1%) were classified as R0, 291 (26.2%) as R(un), and 85 (7.7%) as R1. Our study demonstrated that R(un) was an independent prognostic factor, with adjusted hazard ratios of 1.26 (95% CI, 1.03-1.52) for overall survival and 1.23 (95% CI, 1.03-1.46) for disease-free survival. A proposed classification system with 3 R(un) subcategories revealed a continuum between uncertain and incomplete resections (P < .001).</p><p><strong>Conclusions: </strong>This study validated the updated resection classification for localized NSCLC and highlighted the significant prognostic impact of suboptimal lymph node assessment. These results underscore the heterogeneity among R(un) patients and the need for precise resection assessment to improve outcomes.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537862","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 vs Transcatheter Aortic Valve Replacement in Patients 65 Years of Age and Older.","authors":"Stanley Wolfe, Vikrant Jagadeesan, Lawrence Wei, J W Hayanga, Dhaval Chauhan, R Tyler Evans, Christopher Mascio, J Scott Rankin, Ramesh Daggubati, Vinay Badhwar, J Hunter Mehaffey","doi":"10.1016/j.athoracsur.2025.02.003","DOIUrl":"10.1016/j.athoracsur.2025.02.003","url":null,"abstract":"<p><strong>Background: </strong>Approval of transcatheter aortic valve replacement (TAVR) for all risk profiles has extended TAVR use in patients not otherwise examined in clinical trials. We sought to evaluate contemporary real-world outcomes of surgical aortic valve replacement (SAVR) vs TAVR in Medicare beneficiaries by risk strata.</p><p><strong>Methods: </strong>Using the US Centers for Medicare Services database, all patients aged 65-85 years undergoing isolated first-time SAVR (n = 34,215) or TAVR (n = 124,897) were evaluated (2018-2022). Predicted patient risk accounting for comorbidities simulating The Society of Thoracic Surgeons predicted risk of surgical mortality, but including frailty, were stratified by low (<4%, n = 36,297 TAVR; n = 14,693 SAVR), intermediate (4%-8%, n = 44,026 TAVR; n = 9693 SAVR), or high (>8%, n = 44,574 TAVR; n = 9841 SAVR) risk. Doubly robust risk adjustment with inverse probability weighting and multilevel regression with competing-risk time-to-event analyses compared outcomes.</p><p><strong>Results: </strong>SAVR was associated with higher risk-adjusted in-hospital mortality, acute kidney injury, and bleeding but lower pacemaker rate compared with TAVR across all risk strata (all P < .05). Longitudinal 5-year analysis highlighted that, compared with TAVR, SAVR was associated with superior freedom from composite death, stroke, or valve reintervention in low- and intermediate-risk patients (hazard ratio [HR] 0.85, P = .044, and HR 0.86, P = .039, respectively) as well as lower overall readmission for stroke in low- (HR 0.72, P = .038) and intermediate- (HR 0.78, P = .042) risk patients.</p><p><strong>Conclusions: </strong>In low- and intermediate-risk Medicare beneficiaries, SAVR was associated with higher in-hospital mortality but superior 5-year longitudinal freedom from death, stroke, or valve reintervention compared to TAVR. These data may further enhance heart team decision-making and patient counseling.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524856","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":"Apical Access Management in Transapical Transcatheter Mitral Valve Replacement.","authors":"Tillmann Kerbel, Mirjam G Wild, Michaela M Hell, Harald Herkner, Liliane Zillner, Elmar W Kuhn, Tanja Rudolph, Thomas Walther, Lenard Conradi, Andreas Zierer, Francesco Maisano, Marco Russo, Fabrizio Rosati, Andrea Colli, Miguel Piñón, David Reineke, Gaby Aphram, Christophe Dubois, Jörg Hausleiter, Ralph Stephan von Bardeleben, Martin Andreas","doi":"10.1016/j.athoracsur.2025.01.035","DOIUrl":"10.1016/j.athoracsur.2025.01.035","url":null,"abstract":"<p><strong>Background: </strong>The role of the surgical technique and anatomy in transapical mitral valve replacement are scarcely investigated.</p><p><strong>Methods: </strong>Computed tomography scans, surgical reports and planning slides of 127 patients undergoing transapical mitral valve replacement with the Tendyne valve system (Abbott Vascular) at 15 centers, participating in a European observational study, were retrospectively analyzed and compared between patients with (cohort A) and without (cohort B) apical access complications (AACs).</p><p><strong>Results: </strong>A total of 8 (6.3%) AACs were recorded, of which 7 of 8 were observed in the first 10 patients of the respective center. Patients with AACs showed a trend to a thinner myocardium at the target access compared with those with regular access (median 4.4 vs 6.1 mm, P = .086). Technical difficulties along with AACs were reflected by a significant longer procedural time (median 180 vs 123 min, P = .011), higher rates of circulation support (50% vs 0%, P < .001), valve retrieval (38% vs 3%, P = .005), and bailout full sternotomy (13% vs 0%, P = .063). AACs were related with an intraprocedural mortality and in-hospital mortality rate of 25% (vs 0%, P = .010) and 50% (vs 7%, P = .003), respectively. In total, 8 of 12 in-hospital deaths were attributed to AACs and/or sepsis. AACs significantly increased the risk for 30-day (adjusted odds ratio, 19.5; 95% CI, 2.19-178.3; P = .008) and in-hospital mortality (adjusted hazard ratio, 9.00; 95% CI, 1.95-41.42; P = .005).</p><p><strong>Conclusions: </strong>Access complications in transapical mitral valve replacement are relatively rare but associated with poor short-term outcome. Focus on the apical myocardium within the screening process and specific surgical training might avoid AACs and improve outcome.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524855","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 Association Between Residual Lesion Score and Long-term Outcomes of Congenital Cardiac Operations.","authors":"Teerapong Tocharoenchok, Kok Hooi Yap, Brigitte Mueller, Chun-Po Steve Fan, David J Barron, Osami Honjo","doi":"10.1016/j.athoracsur.2025.01.034","DOIUrl":"10.1016/j.athoracsur.2025.01.034","url":null,"abstract":"<p><strong>Background: </strong>This study sought to investigate the impact of the residual lesion score (RLS) on the long-term outcomes of 5 common congenital heart operations.</p><p><strong>Methods: </strong>All infants who underwent definitive operation for complete atrioventricular septal defect, tetralogy of Fallot (TOF), dextro-transposition of the great arteries, single ventricle (Norwood procedure), and coarctation of the aorta with ventricular septal defect between 2000 and 2012 and who survived until discharge were studied. RLS scores (1, no or trivial; 2, minor; 3, major or in-hospital reinterventions or reoperations for such lesions) were assigned on the basis of postrepair clinical and echocardiographic evaluation. The time to events was summarized using the Kaplan-Meier survival method and competing risk models.</p><p><strong>Results: </strong>A total of 1027 patients were included (213 atrioventricular septal defects, 358 TOFs, 308 dextro-transpositions of the great arteries, 127 single ventricles, and 21 coarctations of the aorta with ventricular septal defects), with a median follow-up time of 15 years (interquartile range, 11-18.4 years). Overall, 227 patients (22.1%) had an RLS of 1, 556 patients (54.1%) had an RLS of 2, and 244 patients (23.8%) had an RLS of 3. Freedom from late death or heart transplantation was 93.7% at 15 years. The RLS was not associated with late death or transplantation. Male sex, TOF, and arterial switch operation had the lowest risk for late death or transplantation. Late reinterventions or reoperations were present in 14.5% at 15 years. Younger age, TOF with pulmonary stenosis repair, arterial switch operation, an RLS of 3 (hazard ratio, 2.02; 95% CI, 1.17-3.51; P = .012), intraoperative surgical revision, and in-hospital reintervention or reoperation were associated with late reintervention or reoperation.</p><p><strong>Conclusions: </strong>The RLS does not predict late mortality but predicts late reintervention or reoperation after congenital cardiac disease repair and can be used to target at-risk patients for follow-up.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477030","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 Role of NLP and AI Tools in Mitigating Workforce Shortages in Healthcare.","authors":"James R Headrick, Mitchell J Parker, Ashley D Miller","doi":"10.1016/j.athoracsur.2025.01.033","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.033","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473331","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 230 Patients Undergoing Surgical Repair of Anomalous Aortic Origin of a Coronary Artery.","authors":"Richard D Mainwaring, Michael Ma, Shiraz Maskatia, Ed Petrossian, Olaf Reinhartz, James Lee, Frank L Hanley","doi":"10.1016/j.athoracsur.2025.01.029","DOIUrl":"10.1016/j.athoracsur.2025.01.029","url":null,"abstract":"<p><strong>Background: </strong>Anomalous aortic origin of a coronary artery (AAOCA) is being identified with increasing regularity and may be associated with myocardial ischemia and/or sudden death. There is an on-going controversy regarding which patients should have medical treatment, which should undergo surgical treatment, and what are the optimal surgical techniques to achieve lasting success.</p><p><strong>Methods: </strong>This was a retrospective review of 230 patients who underwent surgical repair of AAOCA at a single institution. Median age at surgery was 17 years. Preoperative symptoms in 130 patients prompted their referral for surgery, including with sudden death. An additional 32 patients had associated congenital heart defects. Among the cohort, 29% were asymptomatic, 187 had an anomalous right coronary, 43 had an anomalous left coronary, and 192 had an intramural course, whereas 38 did not, including 13 with an intraconal course.</p><p><strong>Results: </strong>An unroofing procedure was performed in 86 patients, 123 underwent coronary reimplantation, the intraconal left main was repaired in 13, and 8 had other procedures. There were no early or late deaths with a median follow-up of 4 years. Recurrent symptoms and/or ischemia resulted in reoperations in 6 patients (2.6%); of these, 3 had anatomic narrowing of the coronary artery and the other 3 had an undiagnosed myocardial bridge. No reoperations were required in the reimplantation group, and 5 reoperations (5.8%) were in the unroofing cohort.</p><p><strong>Conclusions: </strong>Surgical repair of AAOCA can be performed with extremely low mortality and low incidence of reoperation. Our current preference is to perform coronary reimplantation because this mitigates some pitfalls of the unroofing procedure.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473325","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":"Goal-directed Perfusion Strategy During Pediatric Cardiac Operation: Further Detail to Enhance Its Clinical Applicability.","authors":"Feng Long, Ronghua Zhou","doi":"10.1016/j.athoracsur.2025.01.031","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.031","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473320","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":"Sorting Out the Pieces of Fragmented Lung Cancer Care.","authors":"Juan M Farina, Jonathan D'Cunha","doi":"10.1016/j.athoracsur.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.030","url":null,"abstract":"","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473327","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}