Annals of Thoracic Surgery最新文献

{"title":"Paravalvular Leak after Transcatheter Aortic Valve Implantation: Results from 3,600 patients.","authors":"Nav Warraich, James A Brown, Eishan Ashwat, Dustin Kliner, Derek Serna-Gallegos, Catalin Toma, David West, Amber Makani, Yisi Wang, Ibrahim Sultan","doi":"10.1016/j.athoracsur.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.012","url":null,"abstract":"<p><strong>Background: </strong>Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. Mild PVL remains prevalent post-TAVI and its impact on long-term survival is unclear. This study aims to examine the incidence, impact on survival, and progression of PVL.</p><p><strong>Methods: </strong>This was a retrospective, single-institution cohort study of TAVIs between 11/2012-1/2023. Patients were stratified by 30-day PVL severity: none/trace, mild, and ≥ moderate. Multivariable logistic regression was performed to identify risk factors associated with increasing PVL severity. Kaplan-Meier survival estimation and Cox proportional hazards regression were performed.</p><p><strong>Results: </strong>3600 patients underwent TAVI. Of these, 2719 (75.5%) had none/trace PVL, 808 (22.5%) had mild PVL, and 73 (2.0%) had ≥ moderate PVL at 30-days. On multivariable logistic regression, later years of valve implantation (2017-2023) were protective against PVL progression. Kaplan-Meier estimates of the three groups were significantly different (p<0.001) with the ≥ moderate group having reduced survival. On Cox regression, ≥ moderate PVL was associated with increased mortality (HR = 1.80, 95% Cl, 1.31-2.46, p<0.001) while mild PVL was not (HR = 1.01; 95% CI, 0.89-1.15; p=0.88) compared to none/trace PVL. For Kaplan-Meier estimates comparing the none/trace and mild PVL groups alone, landmark analysis showed reduced survival in the mild PVL group after 2-years (p=0.03); however, this late reduction in survival in the mild PVL group did not persist on multivariable analysis (p=0.14).</p><p><strong>Conclusions: </strong>After TAVI, ≥ moderate PVL is associated with reduced survival compared to none/trace PVL. Mild PVL may result in a delayed survival reduction.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081079","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 General Thoracic Surgery Database: 2024 Update on Outcomes and Research.","authors":"Christopher W Towe, Elbert Y Kuo, Andrew Feczko, Biniam Kidane, Onkar V Khullar, Christopher W Seder, Paul H Schipper, James M Donahue, Elizabeth A David, Leigh Ann Jones, Robert Habib, Zouheir ElHalabi, Lisa M Brown","doi":"10.1016/j.athoracsur.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.010","url":null,"abstract":"<p><p>The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) remains the largest and most comprehensive audited thoracic surgical database in the world. As the STS GTSD grows to nearly 1 million cases, the pulmonary resection for cancer and esophagectomy short-term risk models have been refined to provide participants with benchmarked performance reports to facilitate quality improvement efforts. New for 2025 will be the development of long-term risk models and the online release of both short- and long-term risk calculators. A voluntary module to collect neoadjuvant targeted and immunotherapy data has been created has been accepted by participants and is rapidly accruing data. STS GTSD participant public reporting has increased 50% over the last 2 years following the application of the US News and World Report 3% transparency credit. All GTSD data analyses are now performed internally by the STS Research and Analytic Center, resulting in multiple publications through the Access & Publication, Task Force on Funded Research, and Participant User File mechanisms. Future initiatives include the incorporation of patient-reported outcomes into the STS GTSD, revision of the data collection form to incorporate variables associated with long-term outcomes, and focused efforts to increase the value of STS GTSD participation. This report delineates volume trends, recent initiatives, and the prolific research output emanating from the STS GTSD, reflecting a year of substantial progress and academic productivity.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069368","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":"Bioprosthetic Valve Fracture for Transcatheter Aortic Valve-in-Valve Replacement: A Systematic Literature Review.","authors":"Trevor C Chopko, Jonathan N Afoke, Fazal W Khan, Phillip G Rowse","doi":"10.1016/j.athoracsur.2025.01.009","DOIUrl":"10.1016/j.athoracsur.2025.01.009","url":null,"abstract":"<p><p>Transcatheter aortic valve-in-valve replacement presents a viable, minimally invasive approach to replacing degraded bioprosthetic surgical valves. The major drawback of this technique is poor hemodynamics in the form of patient-prosthesis mismatch and high transvalvular gradients. This is commonly attributable to the reduced valvular diameter from the transcatheter heart valve fixed inside the degraded bioprosthesis. Maximizing this diameter by bioprosthetic valve fracture occurs through a noncompliant, high-pressure balloon to splay the degraded valve outward. Despite its novelty, this has demonstrated improved hemodynamic outcomes and optimal valvular expansion with slightly increased operative risk. In this review, we highlight the technique of bioprosthetic valve fracture, types of suitable balloons and valves, timing in relation to valve-in-valve implantation, safety and efficacy, implications, and future directions.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069366","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 National Intermacs Database Risk Model for Durable Left Ventricular Assist Device Implantation.","authors":"Francis D Pagani, Brandon Singletary, Ryan Cantor, J Hunter Mehaffey, Aditi Nayak, Jeffrey Teuteberg, Palak Shah, Jennifer Cowger, J David Vega, Daniel Goldstein, Paul A Kurlansky, Josef Stehlik, Jeffrey Jacobs, David Shahian, Robert Habib, Todd F Dardas, James K Kirklin","doi":"10.1016/j.athoracsur.2024.11.039","DOIUrl":"10.1016/j.athoracsur.2024.11.039","url":null,"abstract":"<p><strong>Background: </strong>Statistical risk models for durable left ventricular assist device (LVAD) implantation inform candidate selection, quality improvement, and evaluation of provider performance. This study developed a 90-day mortality risk model using The Society of Thoracic Surgeons National Intermacs Database (STS Intermacs).</p><p><strong>Methods: </strong>STS Intermacs was queried for primary durable LVAD implants from January 2019 to September 2023. Multivariable logistic regression was used to derive a model based on preimplant risk factors by using derivation (2019-2021 implants) and validation (2022-2023 implants) cohorts. Model performance (derivation and validation cohorts) was assessed using C-statistics, Brier scores, and calibration plots. A refined model (all patients) was generated to calculate observed-to-expected (O/E; 95% CI) ratios for each center.</p><p><strong>Results: </strong>The study population consisted of 11,342 patients from 2019 to 2023 who were sequentially divided in time into derivation (n = 6775) and validation (n = 4567) cohorts. Ninety-day mortality was 8.0% (9.2% in the derivation cohort vs 7.4% in the validation cohort; P = .001). Logistic regression applied to derivation and validation cohorts produced similar discrimination (area under the curve [AUC], 0.714 [95% CI, 0.69-0.74]; and AUC, 0.707; [95% CI, 0.67-0.72], respectively) and calibration (Brier score, .08 vs .07), with overestimation of risk among patients with a predicted risk >0.4. The O/E analysis identified 22 (12.5%) centers with worse than expected mortality with a 95% CI >1.0 and 14 centers (8.0%) with better than expected mortality with a 95% CI <1.0 (all P < .05).</p><p><strong>Conclusions: </strong>The STS Intermacs risk model demonstrated satisfactory discrimination and calibration. This tool may be used to inform candidate selection, facilitate quality improvement, and assess provider performance.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047456","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":"Transcatheter vs Surgical Aortic Valve Replacement in Medicare Beneficiaries With Aortic Stenosis and Coronary Artery Disease.","authors":"Vikrant Jagadeesan, J Hunter Mehaffey, Mohammed A Kawsara, Dhaval Chauhan, J W Awori Hayanga, Christopher E Mascio, J Scott Rankin, Ramesh Daggubati, Vinay Badhwar","doi":"10.1016/j.athoracsur.2024.12.016","DOIUrl":"10.1016/j.athoracsur.2024.12.016","url":null,"abstract":"<p><strong>Background: </strong>As percutaneous therapeutic options expand, the optimal management of severe aortic stenosis (AS) and concomitant coronary artery disease (CAD) is being questioned between coronary artery bypass grafting with surgical aortic valve replacement (CABG+SAVR) and percutaneous coronary intervention with transcatheter aortic valve replacement (PCI+TAVR). This study sought to compare perioperative and longitudinal risk-adjusted outcomes between patients undergoing CABG+SAVR and patients undergoing PCI+TAVR.</p><p><strong>Methods: </strong>Using the Centers for Medicare & Medicaid Services inpatient claims database, the study evaluated all patient aged 65 years and older with AS and CAD who were undergoing CABG+SAVR or PCI+TAVR (from 2018 to 2022). Comorbidities and frailty were accounted for using validated metrics with doubly robust risk adjustment using inverse probability weighting, multilevel regression, and competing-risk time to event analyses. The primary end point was a 5-year composite of stroke, myocardial infarction (MI), valve reintervention, or death.</p><p><strong>Results: </strong>A total of 37,822 patients formed the study cohort (PCI+TAVR, n = 17,413; CABG+SAVR, n = 20,409). Accounting for age, comorbidities, frailty, and number of vessels revascularized, PCI+TAVR was associated with lower procedural mortality (1.1% vs 3.6%; odds ratio [OR], 0.29; P <.001) but higher vascular complications (OR, 6.02; P <.001) and new permanent pacemaker (OR, 1.92; P <.001). However, the longitudinal 5-year primary end point favored CABG+SAVR (20.4% vs 14.2%; OR, 1.44, P <.001). Subgroup analyses demonstrated a benefit in the use of arterial conduit in CABG+;AVR in patients with single-vessel CAD.</p><p><strong>Conclusions: </strong>Among Medicare beneficiaries with severe AS and CAD, CABG+SAVR was associated with higher procedural mortality than PCI+TAVR but lower 5-year risk-adjusted stroke, MI, valve reintervention, and death.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143047773","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":"Anastomotic Leak After Esophagectomy: Analysis of the STS General Thoracic Surgery Database.","authors":"Andrea L Axtell, Clara Angeles, Daniel P McCarthy, James D Maloney, Glen E Leverson, Malcolm M DeCamp","doi":"10.1016/j.athoracsur.2024.12.019","DOIUrl":"10.1016/j.athoracsur.2024.12.019","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak after esophagectomy is a major cause of morbidity and mortality. We sought to identify the prevalence of anastomotic leak, stratified by operative approach and disease etiology, as well as risk factors for leak.</p><p><strong>Methods: </strong>A retrospective cohort analysis using The Society of Thoracic Surgeons General Thoracic Surgery Database was conducted on patients who underwent esophagectomy with gastric reconstruction between 2009 and 2021. Baseline characteristics and postoperative outcomes were compared between patients who did and did not develop an anastomotic leak. Multivariable mixed effects logistic regression models identified risk factors for leak.</p><p><strong>Results: </strong>Of 18,419 patients, 3416 (19%) developed an anastomotic leak. Patients who leaked had more comorbidities, including obesity and diabetes. There was no difference in leak based on disease etiology (P = .435.) Patients with anastomotic leak had increased 30-day mortality (7% vs 4%, P < .001), reoperation (58% vs 10%, P < .001), and longer lengths of stay (18 vs 10 days, P < .001). On multivariable analysis, obesity (odds ratio [OR], 1.27; 95% CI, 1.16-1.38; P < .001), diabetes (OR, 1.14; 95% CI, 1.04-1.25; P = .006), and smoking (OR, 1.26; 95% CI, 1.15-1.37; P < .001) were independently predictive of anastomotic leak. Compared with an open 2-field, a transhiatal (OR, 1.35; 95% CI, 1.17-1.55; P < .001) or 3-field esophagectomy (OR, 1.46; 95% CI, 1.25-1.70; P < .001) was more likely to leak. A robotic approach was associated with an increased risk of leak (OR, 1.28; 95% CI, 1.03-1.08; P < .001), however lost significance in a modern subgroup from 2018-2021.</p><p><strong>Conclusions: </strong>Obesity, diabetes, smoking, pulmonary hypertension, and a cervical anastomosis are risk factors for anastomotic leak regardless of disease etiology. These important clinical risk factors identify an opportunity for modifiable risk reduction with aggressive medical optimization perioperatively.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048699","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":"Malperfusion in Patients with Acute Type A Aortic Dissection: A Nationwide Analysis.","authors":"Nicholas J Goel, John J Kelly, William L Patrick, Yu Zhao, Joseph E Bavaria, Maral Ouzounian, Anthony L Estrera, Hiroo Takayama, Edward P Chen, T Brett Reece, G Chad Hughes, Eric E Roselli, Karen M Kim, Himanshu J Patel, Michael E Bowdish, Jason S Sperling, Bradley G Leshnower, Ourania Preventza, William T Brinkman, Nimesh D Desai","doi":"10.1016/j.athoracsur.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>This study describes in detail the clinical burden of malperfusion associated with acute Type A aortic dissection (ATAAD) in a large, national cohort and the effect of treatment strategy on outcomes.</p><p><strong>Methods: </strong>All patients undergoing repair of ATAAD between 2017 and 2020 in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database were studied. Malperfusion was defined using STS definitions based on imaging or surgeon's evaluation. Multivariable logistic regression was used to analyze the effect of patient and treatment factors on outcomes in patients with and without malperfusion.</p><p><strong>Results: </strong>A total of 9,958 patients undergoing ATAAD repair were studied. Preoperative malperfusion occurred in 27.7% (2,748/9,958) of cases and most often involved the extremity (14.9%, 1,484/9,958), renal (10.2%), or cerebral (9.8%) vascular beds. Operative mortality was much greater among malperfusion patients (26.8% vs 13.6%, P<0.001). After adjustment, coronary malperfusion was associated with the highest odds of mortality (odds ratio [95% confidence interval]=2.28 [1.85-2.81], P<0.001) followed by mesenteric malperfusion (1.82 [1.45-2.28], P<0.001). Cerebral malperfusion was not independently associated with significantly increased odds of mortality (1.14 [0.94-1.38], P=0.18). Partial arch replacement (Zone 1 or Zone 2) compared to ascending aorta or hemiarch replacement only showed similar rate of mortality in patients with malperfusion (24.8% vs 26.9%, P=0.99) and without malperfusion (11.6% vs 13.6%, P=0.54).</p><p><strong>Conclusions: </strong>Preoperative malperfusion in ATAAD was common and associated with significant operative mortality, which varied according to the malperfused region. Partial arch replacement, compared to ascending aorta or hemiarch replacement alone, was not associated with increased mortality.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030226","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":"Insurance-Based Disparities in Cardiac Allograft Vasculopathy Following Heart Transplantation Are Mediated by Care at High Volume Centers.","authors":"Sara Sakowitz, Syed Shahyan Bakhtiyar, Saad Mallick, Sara Pereira, Jennifer Nelson, Rushi Parikh, Robert Higgins, Richard Shemin, Peyman Benharash","doi":"10.1016/j.athoracsur.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic disadvantage and Medicaid insurance have been linked with inferior survival following heart transplantation, yet the contributing mechanisms remain to be elucidated. We evaluated the association of Medicaid with the development of cardiac allograft vasculopathy(CAV).</p><p><strong>Methods: </strong>We considered heart transplant recipients ≥18years within the 2004-2022 Organ Procurement and Transplantation Network. CAV was defined as any evidence of angiographic coronary disease. Institutional volume was computed, with hospitals in the highest quartile (≥19cases/year) categorized as High-Volume Centers. Patients were stratified by insurance into the Medicaid and Non-Medicaid cohorts. The study period was divided into the pre-Affordable Care Act (ACA; 2004-2013) and post-ACA eras (2014-2022).</p><p><strong>Results: </strong>Of 37,073 heart transplant recipients, 4,875(13%) were insured by Medicaid. The overall incidence of CAV was 31%. Following risk-adjustment, Medicaid insurance was linked with significantly greater likelihood of developing CAV over 5 years (Hazard Ratio[HR] 1.08, 95%Confidence Interval[CI] 1.01-1.16). Importantly, this effect seems to have emerged in the post-ACA era (Pre-ACA HR 1.07, CI 0.84-1.36; Post-ACA HR 1.11, CI 1.02-1.21). Furthermore, among patients at High-Volume Centers, Medicaid insurance was linked with similar CAV likelihood (HR 1.04, CI 0.95-1.14). Yet, considering those treated at non-High-Volume Centers, Medicaid was associated with significantly greater CAV hazard (HR 1.14, CI 1.03-1.26). Overall, Medicaid remained associated with inferior patient (HR 1.31, CI 1.21-1.42) and allograft survival at 5-years (HR 1.29, CI 1.19-1.39).</p><p><strong>Conclusions: </strong>Medicaid-insured recipients faced inferior survival and greater risk of CAV over 5-years. Our work encourages closer follow-up and treatment for vulnerable populations in the months and years post-transplantation.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048766","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":"Volume-Outcome Relationship of Norwood Procedures: Insights from the National Pediatric Cardiology - Quality Improvement Collaborative Database.","authors":"Michal Schäfer, Carol McFarland, Venugopal Amula, Dongngan Truong, Linda M Lambert, Eric R Griffiths, Aaron W Eckhauser, S Adil Husain, Reilly D Hobbs","doi":"10.1016/j.athoracsur.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>Prior investigations of the center-specific case volume on outcomes in hypoplastic left heart syndrome have conflicting results. This study utilized the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) registry to investigate the center volume-outcome relationship in patients following the Norwood procedure with consideration of pre-operative high-risk features.</p><p><strong>Methods: </strong>Between 2016 and 2023, centers were categorized by Norwood procedure volume into low (≤ 5 cases/year), medium (6 to 10 cases/year), and high-volume centers (> 10 cases/year). We compared pre-operative high-risk features between the center volume categories and assessed survival outcomes, focusing on 30-day and 1-year mortality. We further compared short-term perioperative morbidity outcomes.</p><p><strong>Results: </strong>We analyzed 3,397 patients from 69 institutions participating in NPC-QIC. Twenty-nine centers were classified as a low-, 20 as medium-, and 20 as high-volume centers. There was no difference in frequency of preoperative high-risk features among the center categories in the majority of considered variables. There was no association between the volume categories and 30-day mortality. Low-volume and medium-volume were associated with higher risk of 1-year mortality. This difference remained when adjusing for the presence of high-risk features (Low: OR (95%CI) 1.40 (1.03-1.60), P=0.020; Medium: OR (95%CI) 1.28 (1.05-1.86), P=0.025). Post-operative comorbidities were more frequent in low-, and medium-volume centers, including the need for diagnostic and interventional catheterization.</p><p><strong>Conclusions: </strong>Patients undergoing Norwood procedure in low-, and medium-volume centers have worse 1-year mortality. The outcome characteristics are potentiated when adjusted for high-risk features with significantly higher survival and lower morbidity in patients treated in high-volume centers.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048175","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":"Redo Surgical Aortic Valve Replacement versus Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Bioprosthetic Valves.","authors":"Jake Awtry, Thais Faggion Vinholo, Mansoo Cho, Philip Allen, Robert Semco, Sameer Hirji, Siobhan McGurk, Paige Newell, Tanujit Dey, Mark J Cunningham, Ashraf Sabe, Kim de la Cruz","doi":"10.1016/j.athoracsur.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.athoracsur.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is associated with improved perioperative safety compared to redo surgical aortic valve replacement (redo-SAVR), but long-term outcomes remain uncertain. We therefore compare long-term outcomes of ViV-TAVR and redo-SAVR.</p><p><strong>Methods: </strong>The study included 1:1 propensity-matched Medicare beneficiaries with degenerated bioprosthetic valves admitted between 09/29/2011 and 12/30/2020 undergoing either redo-SAVR or ViV-TAVR. Exclusion criteria included endocarditis, other concomitant cardiac surgery, or aortic valve re-intervention during the same admission. The primary outcome was 5-year survival. Composite secondary outcomes included major adverse cardiovascular events (MACE; 30-day operative mortality, stroke, or acute myocardial infarction) and major valve event-free survival (congestive heart failure readmission, endocarditis, or aortic valve reintervention). Time-to-event analyses utilized Kaplan-Meier analysis and multivariable Cox proportional hazard modeling.</p><p><strong>Results: </strong>Overall, 4,699 patients were identified including 1,775 redo-SAVR and 2,924 ViV-TAVR patients. Redo-SAVR patients were younger (median[IQR] 72[68,77] vs 79[73,84]) with less CHF(39.6% vs. 68.8%) and prior CABG (17.9% vs. 32.0%) (all p<0.05). In the propensity-matched cohorts of 1,256 patients each, redo-SAVR had higher MACE (17.4% vs 13.2%, p=0.003), but better major valve event-free (71[62,79] vs 43[38,47] months, p<0.001) and 5-year (62.3% vs 46.7%, p<0.001) survival. After stratification by Charlson Comorbidity Index, the long-term survival benefit persisted in patients of lower (67.6% vs 54.9%, p=0.001) and medium or higher-risk (55.1% vs 36.7%, p<0.001).</p><p><strong>Conclusions: </strong>Redo-SAVR may have better long-term survival than ViV-TAVR despite greater perioperative morbidity. Clinical trial data is needed to fully inform clinical decision-making regarding degenerated bioprosthetic valve reintervention, particularly for patients with reasonable life expectancy.</p>","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048768","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}